后节联合前节手术的利与弊

Advantages and disadvantages of combined surgery which consists of posterior segment diseases and anterior segment disease

目的:探讨在后节手术中合并前节疾病(白内障、青光眼、角膜病)联合手术的利与弊,并分析影响手术效果的危险因素。方法:有针对性的分为A组增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR),B组复杂性视网膜脱离(retinal detachment,RD),为了便于对比,又将A组分为A1组:单纯玻璃体切割组;A2组:玻璃体切割+白内障摘除组;A3组:玻璃体切割+白内障摘除+人工晶状体植入术组。将B组分为B1组:单纯玻璃体切割组;B2组:玻璃体切割+白内障摘除组;B3组:玻璃体切割+白内障摘除+人工晶状体植入术组。结果:手术的并发症为主要观察指标,A组为新生血管性青光眼,B组为手术复发或更严重的PVR形成。其并发症的发生率A3>A2>A1,A3明显高于A2和A1,均有统计学意义,A2>A1,但无统计学意义。B组三组的结果与A组三组相同。结论:可能的情况下尽量不选择联合手术,如影响操作则选择非一期植入人工晶状体。

AIM： To discuss the advantages and disadvantages of combined surgery, which consists of posterior segment diseases and anterior segment diseases （ cataract, glaucoma, keratonosus）, and analyze the hazards that may affect surgery. METHODS： Group A： proliferative diabetic retinopathy （PDR）, group B： complicated retinal detachment （RD）. For comparison, group A was divided to group AI： vitrectomy; group A2： vitrectomy ＋ cataract extraction; group A3： vitrectomy ＋ cataract extraction ＋ intraocular lens implantation. Group B was divided to group BI： vitrectomy; group B2： vitrectomy ＋ cataract extraction; group B3： vitrectomy ＋ cataract extraction ＋ intraocular lens implantation. RESULTS： Surgery complications were the main outcome measures： neovascularity secondary glaucoma in group A and surgery recurrence or proliferative vitroretinopathy in group B. The incidence of complication： group A3 〉 A2 〉 A1, A3 was significantly higher than A2 and A1 , and it was statistically significant, A2〉A , but it was not statistically significant. The results of group B were the same as group A. CONCLUSION ： Combined surgery will not be chosen if it is possible, and intraocular lens should not be implanted at once if the operation was influenced.