球形孔源性视网膜脱离手术治疗的临床研究

Clinical study of surgery for bullous rhegmatogenous retinal detachment

目的 探讨用改良的放液、玻璃体腔注气、冷凝、加压（drain-air-cryotherapy-explants,DACE）的手术方式治疗球形孔源性视网膜脱离（bullous rhegmatogenous retinal detachment,BRRD）的疗效.方法 回顾性分析原发性BRRD首次行视网膜脱离手术的患者共38例38只眼.实验组22例22只眼采用改良DACE方式：采用先放液,玻璃体腔注气,再定位冷凝,加压或联合环扎的手术步骤.注气采用玻璃体切割仪注气装置.对照组16例16只眼行常规步骤巩膜扣带术（scleralbucking,SB）：采用先定位冷凝,再放液加压或联合环扎的步骤.随访3-6个月,应用spss13.0统计软件包进行分析,采用四格表Fisher确切概率法（Fisher,sexact probabilities in 2×2 table）检验.以a=0.05为检验水准.结果 一次性手术视网膜复位率及最终复位率,实验组90.9%（20/22）和100.0%（22/22）,对照组87.5%（14/16）和93.8%（15/16）,差异无统计学意义（P=-1.000及P=0.421）;定位裂孔准确率实验组95.5%（21/22）,对照组62.5%（10/16）.差异有统计学意义（P=0.028）;术后最佳矫正视力提高率实验组77.3%（17/22）.对照组56.3%（9/16）,差异无统计学意义（P=0.289）;术后并发症,新裂孔形成及白内障见于实验组,视网膜皱褶及PVR形成进展见于对照组.结论 改良DACE手术方式是治疗上方BRRD安全、有效的方法,可获得满意的手术成功率和较少的并发症.具有术中眼压相对稳定,定位裂孔准确,冷凝精确等特点.

Objective To investigate the effect of the improved drain-air-cryo- therapy-explants （DACE） operation method for bullous rhegmatogenous retinal detachment （BRRD）. Methods The cases of 38 eyes in 38 patients with bullous rhegmatogenous retinal detachment who underwent surgery for the first time were reviewed retrospectively. Experimental group （Improved DACE） enrolled 22 cases （22 eyes） and control group （routine scleral buckling procedure） enrolled 16 cases （16 eyes）. Surgical techniques： In the Experimental Group, applied the operating procedure of drainage and air injection first, then reregistered cryocoagulation, inflating or combine the cerclage. Pour gas via vitrectomy equipment. In the Control Group,applied the operating procedure of reregistering cryocoagulation, then inflating or combine the cerclage. All the cases were followed up 3～6 months. All the factors were observed with SPSS 13.0 statistical package,use Fisher,s exact test, the size of the test is a =0.05. Results The retinal reattached ratio of the single-operation and the last-operation： the Experimental Group was 90.9% （20/22） and 100.0% （22/22）. The Control Group was 87.5% （14/16） and 93.8% （15/16）,the distinction had no statistical significance （P =1.000 and P =0.421）. The accurate ratio of hole/tear location： the Experimental Group was 95.5% （21/22）, the Control Group was 62.5% （10/16）, the distinction had statistical significance （P =0.028）; The advanced ratio of the best corrected vision after the surgery： the Experimental Group was 77.3% （17/22）,the Control Group was 56.3% （9/16）,the distinction had no statistical significance （P =0.289）; The postoperative complications： new hole/tear and cataract in the Experimental Group exceeded the Control Group,however,the retina reductus and PVR advancement were lower than the Control Group. Conclusions The improved DACE technique is a safe and effective method to treat the above tuberositas higher rhegmatogenous retinal detachment, with the characteristic of relatively stable intraocular tension duting the operation, exact hole/tear location, precise cryotherapy and etc.