麻痹性内斜视分期手术疗效探讨

The analysis of surgery by stages for paralytic esotropia

目的观察麻痹性内斜视分期手术治疗效果。方法对15例麻痹性内斜视患者，采取眼外肌分期手术治疗，一期手术后徙患眼内直肌，缩短患眼外直肌；二期手术行患眼上下直肌颞侧半与外直肌联结术。术后随访观察手术疗效。结果平均随访18月发现，2例患者仅通过一期手术即可矫正斜视，3例患者一期手术后初期达到正位，6周后手术效果回退，二期行直肌联结术达到正位；10例患者一期手术后眼位部分改善，仍有欠矫，二期手术后7例恢复正位，3例仍有部分欠矫。结论麻痹性内斜视采取分期手术治疗。有可能使部分患者仅通过相对损伤较小的一期手术获得满意的远期疗效，即使一期手术仍有欠矫，接受二期直肌联结术后多数患者可获得较为理想的远期效果。

Objective To observe the effective of surgery by stages for paralytic esotropia. Methods Fifteen patients with paralytic esotropia accepted the surgery by stages that included the recession-resection procedure in first and the Jensen＇s procedure secondly. Results Mean follow-up was 18 months, 2 patients could accept orthopia from the first stage surgery, 3 patients accepted orthopia early from the first stage surgery but the effective lowered after 6 weeks and had orthopia from the secondly Jensen＇s procedure; 10 patients＇ ocular deviation improved partly from the first stage surgery, in which 7 cases accepted orthopia from the second stage surgery and 3 cases had still be undercorrected. Conclusions Surgery by stages for paralytic esotropia made some patients accept good long-time effect from the first stage surgery, even though the effect is undercorrected, those patients could have comparatively ideal forward curative effect from the second stage surgery.