三种手术方法治疗有牵引孔源性视网膜脱离的临床分析

The clinical analysis of three surgical methods for tractional rhegmatogenous retinal detachment

目的探讨局部干性玻璃体切割联合注气、局部外垫压在有牵引孔源性视网膜脱离中临床疗效及安全性。方法选择临沂市人民医院有牵引孔源性视网膜脱离患者60例(60眼),随机分为干性玻璃体切除组(试验组20眼)、标准玻璃体切除组(内路组20眼)、常规巩膜外垫压组(外路组20眼),各组分别进行各自的手术方式,术后随访1～6个月,主要观察视网膜复位率、屈光度变化及并发症。结果术后1个月试验组与内路组视网膜复位率达100%,外路组视网膜复位率达80%(P<0.05);随访6个月试验组治愈率95%,外路组治愈率60%(P<0.05)。结论对裂孔位于4点和8点水平以上、赤道部周围,尤其瓣缘有明显卷边、瓣周有明显玻璃体牵引的孔源性视网膜脱离患者,孔周局部干性玻璃体切除联合注气和外垫压手术,有利于一次性复位视网膜,最大限度的挽救患者视功能。

Objective To explore the clinical effects and safety in the treatment of tractional rhegmatogenous retinal detachment with the therapy of local dry vitrectomy combined with pneumatic retinopexy and scleral buckling.Methods 60 selected cases of tractional rhegmatogenous retinal detachment（60 eyes） were divided into three groups（the test group,the traditional buckling group,vitrectomy group） at random.The test group was treated with the therapy of scleral freezing combined with scleral buckling without drainage,and vitreous traction of tears was removed by local dry vitrectomy under microscope.Pneumatic retinopexy was performed on the room around the tears.Traditional buckling was performed on the traditional buckling group and the standard vitrectomy was performed on the third group.anatomic reattachment rate and complcation were observed.Results One month after operation the anatomic reattachment rate of the test group reached 100%,another group reached 80%（P0.05）.During 6 months follow-up,The final anatomic reattachment rate of the test group reached 95%,while another group reached 60%（P0.05）.Conclusions Local dry vitrectomy combined with pneumatic retinopexy and scleral buckling is an effective and safe operation to increase the anatomic and visual success rate of one operation for the tractional rhegmatogenous retinal detachment.