表面麻醉小切口白内障囊外摘出术在“流动手术车”的应用

The application of small-incision manual extracapsular cataract extraction using topical anesthesia in preventing blinding of mobile operating vehicle

目的探讨表面麻醉小切口白内障囊外摘出术在"流动手术车"防盲手术应用的可行性。方法617例(617眼)白内障分为表面麻醉组292例及球周麻醉组325例。行小切口白内障囊外摘出、联合人工晶状体植入术。观察麻醉效果,对比分析术后视力及手术并发症。结果617眼麻醉成功率99.67%,未出现麻醉意外及全身并发症,两组术后第1天最佳矫正视力>0.5者及手术并发症差别无统计学意义(P>0.1)。球周麻醉组:12.31%球结膜水肿,5.23%球结膜下出血,8.31%眼睑皮肤青紫淤血,0.31%球后出血,6.46%眼外肌麻痹,表面麻醉组:未出现以上麻醉并发症。结论表面麻醉小切口白内障囊外摘出、人工晶状体植入术具有麻醉效果好、安全性高、适应症范围广、术后外眼美观等优点,特别适于在"流动手术车"防盲手术中开展。

Objective To investigate the feasibility of smallincision manual extracapsular cataract extraction （ECCE） usingtopical anesthesia in preventing blinding of mobile operating vehicle. Methods 617 eyes with cataract were divided into 2 groups： ECCE using topical anesthesia （292 eyes） and ECCE using peribulbar anesthesia （325 eyes）. Benoxil 0.4% solution was used on topical naesthesia group before operation 10 minutes for 5 - 7 times. Pefibulbar anesthesia was used the latter group（2% hudrochloric acid lidocaine and 150u hyaluronidase）. The both of operation manner were extracapsular cataract extraction and intraocular lens implantation. The naesthesia effect, eyesight and operative complication were analyzed. Results Anesthesia succeed rate of 617 eyes is 99. 3%. We didn＇t find naesthesia suddenness and complications. The best spectacle-corrected visual acuity of the 2 groups was 20/40 or better（P 〉 0.1 ）. The operative complication of peribulbar anesthesia group include 12. 3% chemosis, 5. 2% subconjunctival hemorrhage, 8.3% ecchymosis, 0.8% retrobulbar hemorrhage and 6.4% ophthalmoplegia externa. We didn＇ t find all the complications on the topical anesthesia group. Conclusions The merits of small-incision manual extracapsular cataract extraction （ECCE）using topical anesthesia include well anesthesia effect, favorable security, extensive indication, esthetical postoperative appearance and so on, and it was suitable on the mobile operating vehicle.