马来西亚综合医院后囊破裂的诱发因素与相关性及结果分析

摘要

AlM: To see the causative factors, associations and outcomes of posterior capsule rupture ( PCR) .METHODS:A retrospective cohort study was done of all patients with PCR from 2007 to 2014 in Melaka Hospital. Associations between ocular comorbidities, lens related complications, surgeon grade, type of cataract surgery, whether done alone or in combination, with the occurrences of PCR were studied. The final visual outcome of cases with PCR was studied. RESULTS: PCR was the commonest intraoperative complication ( n = 623, 4. 8%) among 12 846 patients. Ocular comorbidities and status of the lens did not cause PCR. Experience and seniority of surgeons were significantly associated with PCR. Medical officers had more PCRs than gazetting specialists (P=0. 0000), who inturn had more PCRs than specialists (P=0. 000). Each type of cataract surgery done was also significantly associated with PCR-phacoemulsification ( phaco) , phaco convert to extracapsular cataract extraction ( ECCE ) and intracapsular cataract extraction (lCCE) (P=0. 000), lens aspiration (P=0. 020), and ECCE (P=0. 003). Specialists got good outcomes compared to trainees without PCR occurring (P=0. 001) and also with PCR occurring (P=0. 013 ) . However, no difference was observed in the occurrence of PCR in complicated cases between specialists and trainees. Vision was compromised mainly by astigmatism following PCR. lmpaired vision ( P =0. 000) and poor vision (P=0. 000) were more than good vision. Poor vision was more in PCR compared to other complications. (P=0. 000).CONCLUSlON: PCR occurs in all types of cataract surgeries and is the main intraoperative complication causing poor vision. Good outcomes were significantly more when specialists got PCR compared to trainees. Junior surgeons should practice in wet labs and be given more cases.%目的：：观察后囊破裂的诱发因素、相关性及结果。方法：回顾性研究。研究对象为2007~2014年我院出现后囊破裂患者。研究后囊破裂与眼部合并症、晶状体相关并发症、手术水平、手术类型、独立手术或联合手术的相关性,及患者最终视力情况。结果：在12846名患者中,后囊破裂是最常见的术中并发症(n=623,4.8%)。眼部合并症和晶状体状态不会引起后囊破裂。手术者的经验和资历与后囊破裂发生的相关性显著。基层医务人员手术时出现后囊破裂比知名专家多(P=0.0000),而知名专家手术时出现后囊破裂情况反而比一般专家多(P=0.000)。白内障手术中出现后囊破裂与下列手术方式显著相关：超声乳化术、超乳转囊外摘除术及囊内摘除术(P=0.000),晶状体吸出术(P=0.020)和白内障囊外摘除术( P=0.003)。术中发生( P=0.013)与未发生(P=0.001)后囊破裂时,专家均比学员的手术结果好。尽管如此,在复杂病例中,专家与学员术中出现后囊破裂无显著差异。后囊破裂致视力损害的主要原因是散光。视力丧失(P=0.000)和低视力(P=0.000)出现较多。相对于其它并发症,后囊破裂更易致低视力。结论：后囊破裂会发生在所有类型的白内障手术中,且是引起术后低视力的主要术中并发症。专家在处理后囊破裂的手术结果优于学员。因而初级外科医生应加强手术练习。