马蹄形裂孔视网膜脱离玻璃体手术治疗的技术及其效果

The Techniques and Effects of Vitrectomy for Retinal Detachment Caused by Horse-shoe shaped Tear

目的探讨马蹄形裂孔视网膜脱离玻璃体手术治疗的要点及其影响因素。方法回顾性研究玻璃体手术治疗马蹄形裂孔视网膜脱离患者110例(110眼)的临床结果,对术中处理裂孔边缘粘连牵引、重水应用、气液交换吸出网膜下液、激光或冷凝封闭裂孔、惰性气体充填等技术进行分析和比较性研究。结果1.行施玻璃体手术后裂孔封闭视网膜脱离复位一次性成功者共93例(84.6%)。其中5例因裂孔封闭不全随即再次手术治愈。12例在随访中发现有新裂孔形成,视网膜再脱离,7例接受再次手术治愈。2例激光光凝治愈。2.术中42例用重水压平视网膜行裂孔边缘处膜切除,其中35例治愈(83.3%);68例直接行膜切除松解牵引灶,其中58例治愈(85.3%)。二者无统计学差异(x2=0.072P>0.05)。3.在裂孔处行气液交换内放液,其中47例全气液交换40例治愈(85.1%);63例行部分气液交换以裂孔贴附为准,其中53例治愈(84.1%)。二者无统计学差异(x2=0.13P>0.05)。4.气液交换后用激光封闭裂孔34例,其中24例治愈(70.58%),用巩膜外冷凝法76例,其中69例治愈(90.78%)。二者相比冷凝的效果好(x2=5.48P<0.05)。结论马蹄形裂孔视网膜脱离采用玻璃体手术重点在切除裂孔边缘粘连牵引,应用重水和气液交换以裂孔贴附为度。冷凝比激光封闭的效果要好。

Objective To investigate the points and influence factors of the vitrectomy treating the retinal detachment caused by horse-shoe shaped tear. Method Retrospectively studying the surgery results of 110 cases of retinal detachment caused by horse-shoe shaped tear with vitrectomy. Each procedure during the operation were compared with and analyzed, such as use perflurodecaline or not to cut traction and adhesion on the edge of the tear, gas-liquid exchange completely or partly, sealing the tear whether by photo-coagulation or by cryocoagulation. Results 1 .Total 93 cases（84.6%） succeed whose the tear were sealed and the retina were reattached by once operation. In which, five cases were treated through the second operation because of the tear re-opened, and twelve cases were found new tears and the retina detached again. In the twelve cases, seven of them were cured through the second operations and two cured with photo-coagulation. 2.42 cases were treated with perfiurodecaline cutting the adhesions and membranes on the edges of the tear and 35 cases succeed （83.3%）. 68 cases were treated with cutting the adhesion directly and without perflurodecaline, in which 58 cases succeed （85.3%）. There was no remarkable difference between two groups （x^2=0.072 P〉0.05）. 3. With the gas-liquid exchange to drain away the sub-retinal liquid through the tear, 47 cases were completely exchanged and 40 cases succeed （85.1%）. 63 cases were partly exchanged provided the edge of the tear attached and 53 cases succeed （84.1%）. There was no remarkable difference between two groups （x^2 =0.13 P〉0.05）. 4.34 cases were treated with photo-coagulation to seal the tear and 24 cases succeed （70.58%）. 76 cases were treated with cryo-coagulation to seal the tear and 69 cases succeed（90.78%）. The effect of the cryo-coagulation was better （x^2 =5.48 P〈0.05）. Conclusion The point of the vitrectomy treating retinal detachment caused by horse-shoe shaped tears was to cut the adhesion and traction on the edge of the tear thoroughly. It should be according to the edge of the tear attached degree to decide whether use perflurodecaline or not, completely gas-liquid exchange or partly gas-liquid exchange.The effect of cyro-coagulation to seal the tear was better than photo-coagulation.