应用20G玻璃体切除改良自闭式巩膜隧道切口的三年结果分析

Three years results of modified self-sealing sclerotomies for twenty-gauge pars plana vitrectomy

目的评价1．2mm长的自闭式巩膜隧道切口在20G玻璃体切除手术中的安全性和有效性。方法回顾性研究511例（511眼）用月形刀做长度为1．2mm的鼻上和颞上两个半层巩膜隧道，显微玻璃体视网膜刀（MVR）经巩膜隧道到达末端时竖起，垂直巩膜刺穿下方半层巩膜进入玻璃体腔，然后在颞下方用巩膜穿刺刀做常规穿刺，缝线固定灌注管行常规玻璃体手术或晶状体超声乳化联合玻璃体手术。结果2006年3～12月99例的198个自闭式巩膜隧道切口中，有171可以自闭，占86．4％。2007年178例中356个自闭式巩膜隧道切口中，有320个可以自闭，占89．9％。2008年234例的468个自闭式巩膜隧道切口中，427个可以自闭，占91．2％。所有病例中，没有观察到气体或硅油漏出的现象。2009年至今，由年轻医生完成的切口自闭率也超过80％。结论改良自闭式巩膜隧道切口安全、方便。睑裂较小者也能很好使用。随着操作的熟练，切口的自闭率可逐渐提高。

Objective To evaluate the safety and effectiveness of 1.2mm self-sealing sutureless sclerotomy in twenty-gauge pars plana vitrectomy. Methods This is a retrospective study. We shortened the two superior scleral tunnels to 1.2 mm, then perforation was performed at the end of the tunnels and the selera was pierced perpendicularly with a mierovitreoretinal （MVR） blade through the scleral tunnel. After that, the inferotemporal incision for infusion was performed in a classic way with a MVR knife. This modified technique was applied to 511 patients that received phaeo combined primary pars plana vitrectomy or primary pars plana vitrectomy from March 2006 to December 2008. Results There were 511cases （511 eyes） in- cluded from March 2006 to December 2008. Among them there were 281 males with 281 eyes, 230 females with 230 eyes, ranging from 18 to 93 years old, averaged 53.4 ± 13.4. There were 348 cases （348 eyes） of retinal detachment, 92 cases （92 eyes） of diabetic retinopathy, and 71 cases （71 eyes） of others. In 2006, from March to December, 171 of 198 sclerotomies （86.4%） among 99 patients did not require suturing. In 2007, 320 of 356（89.9% ） selerotomies among 178 patients were sutureless. In 2008, 427 of 468 scleroto- mies （91.2%） among 234 patients were self-sealing. None of the incision-related complications needed fur- ther intervention. No gas or silicone oil leakage was observed. From 2009 till now, the selfsealing rate was still higher than 80% even the operation was performed by junior doctors. Conclusion Modified self-seal- ing sutureless sclerotomy is safe and convenient. It is particularly suitable for patients with narrow palpebral fissures. The self-sealing rate can also be increased with the improvement of surgical skill.