部分气液交换免缝合两切口硅油取出术的临床疗效观察OACSTPCD
Efficacy evaluation of active silicone oil removal with a sutureless transconjunctival vitrectomy system through partial fluid-air exchange in clinical practice
目的 探讨部分气液交换免缝合两切口硅油取出术效果及其安全性.方法 回顾性分析2020年12月至2022年1月在徐州医科大学附属沭阳医院接受玻璃体腔硅油取出手术的49例(53只眼).患者临床资料,A组:27只眼行部分气交免缝合两切口23G硅油取出术;B组:26只眼行传统两切口23G硅油取出术.两种手术方式均先做传统23G两通道,经颞下扁平部灌注,颞上注射器手动抽吸玻璃体腔内硅油.A组改良术式采用巩膜隧道切口,术末采用消毒空气注入玻璃体腔置换部分灌注液,免缝合巩膜穿刺口;B组传统术式术末直接拔出颞下灌注管,8-0可吸收缝线缝合巩膜穿刺口.比较两种手术方式总手术时间、取油时间、术后眼表出血发生率、患者异物感评分,术前及术后1 d、7 d、1个月的眼压和最佳矫正视力(BCVA)变化,以及术中和术后并发症发生率.结果 53只硅油眼均顺利取出硅油,术中未发现明显的并发症;两组取油时间、眼压及BCVA比较,差异均无统计学意义(均P>0.05);A组总手术时间短于B组,差异有统计学意义(P<0.001).B组术后1 d眼表出血5只眼,A组3只眼;术后1 d、7 d、1个月A组眼表异物感评分均显著低于B组(均P<0.001).B组传统术式中,术后眼表出血率46.2%,出现玻璃体混浊3只眼(11.5%),而改良术式术后眼表出血率11.1%,未观察到并发症.结论 部分气交免缝合两切口23G硅油取出术可有效降低术后眼表出血发生率,改善患者术后异物感,且安全性好,值得临床推广应用.
Objective To investigate the curative effect,timeliness,and safety of active silicone oil(SO)re-moval with a 23-gauge(G)sutureless transconjunctival vitrectomy system through partial fluid-air exchange.Methods A retrospective case-control study.From December 2020 to January 2022,53 siliconized eyes underwent SO removal with two different techniques in the affiliated Shuyang Hospital of Xuzhou Medical University.They were divided into the modified-technique group(Group A,27 eyes)and the traditional-technique group(Group B,26 eyes).Both techniques first made two 23G sclerotomies,with an inferior-temporal cannula for infusion and a superior-temporal cannula for SO removal.Sub-sequently,the operator partially replaced the infused fluid with sterilized air and no suturing was done in group A,while direct removal of the infusion cannula followed by 8-0 suturing of the incision was done in group B.Statistical analyses were performed in terms of operative time,intraocular pressure(IOP)and best-corrected visual acuity(BCVA)before and 1 day,7 days and 1month after the surgery,and adverse responses including subconjunctival hemorrhage,foreign body sen-sation,and intraoperative and postoperative complications were also evaluated.Results SO was removed successfully in all patients with no intraoperative complication.There was no statistical difference between two groups in terms of SO re-moval time,IOP,and BCVA(all P>0.05).Group A exhibited significantly shorter surgery time than Group B(P<0.001),and reduced subconjunctival hemorrhage.The postoperative foreign body sensation evaluation 1 day,7 days,and 1 month in Group A were also significantly lower than that in Group B,respectively(all P<0.001).Besides,in Group B,the percentage of subconjunctival hemorrhage was 46.2%and 3 eyes exhibited vitreous floaters(11.5%)postoperatively while the percentage of subconjunctival hemorrhage was 11.1%and none of the postoperative complications were observed in Group A.Conclusions Active SO removal with a 23G sutureless transconjunctival vitrectomy system through partial fluid-air exchange is a potential modified technique for reducing subconjunctival hemorrhage and postoperative discomfort with satisfying effectiveness and safety,which is worth wider application in clinical practice.
王亮;张敏玉;张苏红;郭晓梅;李甦雁
221116 徐州医科大学附属徐州市立医院眼科221116 徐州医科大学附属徐州市立医院眼科223600 徐州医科大学附属沭阳医院眼科223600 徐州医科大学附属沭阳医院眼科221116 徐州医科大学附属徐州市立医院眼科
硅油23G免缝合眼表出血异物感气液交换
Silicon oil23 gaugeSuturelessSubconjunctival hemorrhageDiscomfortGas-fluid exchange
《临床眼科杂志》 2024 (6)
517-521,5
徐州市社会发展重点专项项目(KC21153)
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