视神经不离断的眼内容物剜除并Ⅰ期义眼台置入术

Non-optic nerve transecting evisceration combined with first stage hydroxyapatite orbital implantation

目的探讨视神经不离断的眼内容物剜除并I期义眼台置入术的临床疗效。方法对122例患者（122只眼）随机分成A、B两组，术中均先行常规眼内容物剜除术，自颞上至鼻下象限斜行剪开巩膜全层，剖分巩膜壳为两瓣，并放置HA义眼台。两组术中处理视神经的方式不同：A组为传统球后视神经离断，B组为沿视乳头周围2mm做圆形巩膜剪开。对术中止血时间、球结膜缝合张力、疼痛、义眼台置入后睑裂大小、手术时间；对术后疼痛、球结膜水肿和充血、义眼片佩戴时间行对比分析。结果A、B两组术中压迫止血时间分别为（23．46±6．96）mm和（5．49士1．72）min，球结膜缝合张力评分分别为3．39±0．74和0．45±0．59，手术时间分别为（79．44±10．81）min和（43．46±8．43）min；术后首日疼痛评分分别为2．8±0．68和1．47士0．67，义眼片佩戴时间分别为（6．27±2．73）周和（3．07±2．11）周。以上指标两组间差异均有统计学意义（P〈O．01）。结论与传统球后视神经离断组相比，视神经不离断的眼内容物剜除并I期义眼台置入术具有术中损伤小、耗时短、术后疼痛轻、恢复快的优势。

Objective To observe the clinical effects of a new method： non-optic nerve transec- ting evisceration combined with first stage hydroxyapatite orbital implantation. Methods One hun- dred and twenty two eyes （122 cases） were randomly divided into group A and group B, evisceration was first undertaken, the scleral wall was superior-temporally to inferior-nasally dissected and double scleral petals were placed before the implanted hydroxyapatite artificial eyeball. The difference be- tween group A and group B was.. in group A, the optic nerve was transected behind the eyeball, but in group B, a 2 mm outside the optic nerve scleral circle cutting was taken. Hemostasis time before im- plantation, tensile force during conjunctival suture, pain during surgery, palpebral fissure height after eye speculum wearing, operation time consuming, pain after surgery, conjunctival edema and conges- tion, and ocular prosthesis wearing time were compared between the two groups. Results In groups A and B, the intra-operative hemostasis time were （23.46：1：6. 96）mins and （5.49：1： 1.72）mins, the tensile force score during conjunctiva suture were 3.39 ± 0.74 and 0. 45±0. 59, the score of pain in the first day were 2. 8±0. 68 and 1. 47± 0. 67, the ocular prosthesis wearing time after surgery were （6.27±1-2.73） and （3.07 ±2. 11）weeks, respectively. The differences of all the parameters above were with statistical significance between groups A and B （P〈0.01）. During 2 years follow-up, no complications such as orbital implant exposure or infection happened. Conclusions Compared to tradi- tional methods, the non-optic nerve transecting evisceration method has merits of less impairment, short time-consuming, less pain, and quicker postoperative recovery.