低龄儿童不同类型斜视手术远期疗效

Analysis the long-term outcome of surgery for different type strabismus in children younger than age 3 years

目的分析早期手术治疗儿童斜视的远期疗效，探讨低龄儿童不同类型斜视的手术时机和设计。方法手术治疗397例3岁以下斜视患儿，手术后随访6～144个月，观察术后眼位、双眼单视功能及二次手术情况。结果（1）外斜视组、垂直分离性斜视（DVD）组远期正位率分别为78．1％、68．4％，低于术后正位率，P〈0．05；内斜视组、上斜肌麻痹（SOP）、A—V综合征及特殊类型斜视远期正位率与术后正位率无差异，P〉0．05。（2）各组远期立体视〈800”的比率均高于术前，P〈0．05。（3）发病年龄早、伴有垂直斜视及术后一周欠矫或过矫是影响内、外斜视术后远期效果的主要因素，P〈0．05；手术年龄在24个月内与25-36个月远期眼位无差别，P〉0．05。结论（1）内斜视，SOP及A—V综合征，3岁前手术远期眼位较满意并有利于立体视功能。（2）内、外斜视近期应适度欠矫和过矫，以＋10^△之内为宜。垂直斜视诊断明确者尽量一次手术，特殊类型斜视宜选分次手术。

Objective To analyze the long-term outcome of early surgical treatment, to review the operation design and timing of different types of strabismus in young children. Methods A total of 397 strabismus cases received operation under 3 years old, postoperative follow-up 6 to144 months, position of eye, binocular vision and second operation were reviewed. Results （1）The long term orthophoria rate of exotropia and DVD was 78.1%, 68.4%, lower than postoperative, P 〈0.05; The orthophoria rate of esotropia, SOP, A-V syndrome and special strabismus had no significant difference at long-term follow-up, P 〉0.05. （2）The ratio of 〈800, of binocular vision of different group were higher than the preoperative at long-term follow-up, P 〈0.05. （3）The occurrence age early, accompanied by vertical strabismus and postoperative position of eye more or less proper was primary factor for position of eye at long-term follow-up, P 〈0.05. Conclusions （1）For esotropia, SOP and A-V syndrome, operation under 3 years old contribute to orthophoria and binocular vision at long-term follow-up. （2）The operation design of esotropia and exotropia should be moderate more or less prop- er ＋10^△. The vertical strabismus should design for once as possible, specific strabismus choose divide into two period operations.