经结膜免缝合20G穿刺套管刀行常规玻璃体切割术的临床观察

摘要

目的 观察经结膜免缝合20G穿刺套管刀行常规玻璃体切割术的临床效果.方法 回顾性分析行玻璃体切割手术62例63只眼的临床资料.按手术方式分为2组,A组:20G经结膜免缝合穿刺套管完成常规玻璃体切割术33例34只眼.男性19例,女性14例;年龄17～75岁,平均年龄52.3岁;平均视力0.04;平均眼压18.25 mm Hg(1 mm Hg=0.133 kPa).糖尿病视网膜病变(DR)13例;玻璃体积血9例;硅油眼取油剥膜2例;复杂视网膜脱离9例;黄斑前膜剥离1例.B组:常规20G切口玻璃体切割术29例29只眼.男性13例,女性19例;年龄24～69岁,平均年龄49.5岁;平均视力0.02,平均眼压17.50mm Hg.糖尿病视网膜病变10例;单纯玻璃体积血8例;视网膜脱离5例;陈旧性视网膜脱离玻璃体切割联合巩膜环扎2例;硅油眼取油剥膜注气4例.A组34只眼中行眼内激光光凝21只眼,巩膜外冷冻封闭裂孔9只眼;惰性气体填充3只眼,硅油填充15只眼.手术后记录并分析切口渗漏情况,医源性裂孔如发生率及记录患者舒适度.计数资料采用χ2检验.结果 A组34只眼中31只眼穿刺口自闭性良好,无需特别处理,切口无渗漏,手术后舒适度好,3只惰性气体填充眼需压迫3～5 min,且颞下切口均有气体溢出,缝合1针.B组所有患者巩膜结膜切口均8-0丝线缝合,无切口渗漏.异物感明显刺激症状重;舒适度两组比较,差异有统计学意义(χ2=50.56,P<0.01);A组34只眼均未发生医源性裂孔,B组2只眼发生穿刺口旁锯齿缘裂孔,两组比较,差异有统计学意义(χ2=4.15,P<0.05).结论 经结膜免缝合20G穿刺套管刀行常规玻璃体切割术,使常规玻璃体切割手术简单快捷,显著的减少了医缘性裂孔发生率,使手术更安全.%Objective To observe the clinical effect of conventional vitrectomy using transconjunctival sutureless 20 Gauge (20G) trocar.Methods The clinical data of 62 patients (63 eyes) who had undergone vitrectomy were retrospectively analyzed.The patients were divided into 2 groups according to the surgery methods.Group A: conventional vitrectomy using transconjunctival sutureless 20G trocar were performed on 33 cases (34 eyes) including 19 males (20 eyes) and 14 females (14 eyes).The patients aged from 17 to 75 years with the average age ot 52.3 years.The average visual acuity was 0.04 and the average intraocular pressure was 18.25 mm Hg (1 mm Hg=0.133 kPa).Included were 13 cases of diabetic retinopathy,9 cases of vitreous hemorrhage,2 cases of silicone oil removal and tearing membrane off,9 cases of complex retinal detachment,and 1 case of tearing epiretinal macular membrane.Group B: 20G conventional incision vitrectomy was performed on 29 cases (29 eyes) including 13 males (13 eyes) and 16 females (16 eyes) aged from 24 to 69 years with the average age of 49.5 years.The average visual acuity was 0.02 and the average intraocular pressure was 17.50 mm Hg.Included were 10 cases of diabetic retinopathy,8 cases of vitreous hemorrhage,5 cases of retinal detachment,2 cases of long-standing retinal detachment performed with vitrectomy and scleral buckling,and 4 cases of silicone oil removal and tearing membrane off and intravitreal injection of expanding gases.Within group A,21 eyes were treated with intraocular laser photocoagulation,9 eyes were treated with scleral cryosurgery to block the hole,3 eyes were treated with intravitreal injection of expanding gases,and 15 eyes were injected with silicone oil.Leakage of incision,incidence of iatrogenic holes and comfort of patients after operation were recorded and analyzed.All data were analyzed by χ2 test statistical analysis.Results In group A,31 eyes had a good degree of comfort without incision leakage and did not need special treatment;3 eyes filled with inert gas needed suppression for 3 to 5 minutes,and had gas spill from the temporal incision,which needed to be sutured once.In group B,all incisions were sutured with 8-0 silk suture without any incision leakage,whileforeign body sensation and irritation was apparent.Difference on the degree of comfort in the two groups was statistically significant (χ2 = 50.56,P<0.01).No eyes in group A generated iatrogenic hole,while 2 eyes in group B generated ora serrata slit pores next to the puncture.Compared with each other, there was a significant statistical difference (χ2= 4.15,P<0.05).Conclusion Conventional vitrectomy using transconjunctival suturcless 20G trocar made the vitrectomy simpler and quicker and can reduce the incidence of iatrogenic hole significantly.