严重眼球破裂伤急诊手术治疗分析

Clinical analysis of emergency surgery on the serious eye ball ruptures injury

目的对严重的开放性眼球破裂伤，采取I期急诊手术和治疗效果的评价，对Ⅱ期手术选择恰当的手术时机及疗效进行探讨。方法文中34例34只眼患者，全部为单眼严重角巩膜破裂伤，均施行急诊I期清创缝合修补术，术后予以抗炎、抗感染、对症及支持疗法，控制眼内感染，进一步完善各项检查，为Ⅱ期手术提供条件。结果对34例34只眼患者，积极施行I期手术治疗后，有10例10只眼视力恢复较好，未再施行Ⅱ期手术治疗；有23例23只眼施行了Ⅱ期手术治疗；另有1例1只眼多部位组织损伤较重，经I期以及Ⅱ期手术治疗，最终有29例占全部患者的85．3％视力≥指数，最佳者达0．5～0．6。结论发生严重的开放性眼球破裂伤后，无论伤眼有无光感，都应积极地尽快施行急诊I期手术治疗，术后加强抗炎、抗感染、对症及支持疗法，防止并发症的发生，完善各项检查，为Ⅱ期手术积极创造条件，对挽救眼球、恢复视功能、提高不同程度视力，起着关键性的作用。

Objective To evaluate the treatment effect of taking stage l emergency surgery on open eye ruptures, to explore the appropriate timing of surgery and the efficacy of the Phase II sur- gery choices. Methods Thirty-four cases （34 eyes）, all had monocular serious corneoscleral rupture were taken the purposes of emergency I debridement repair, postoperative anti-inflammatory, anti-in- fective, symptomatic and supportive therapy to control intraocular infection, and further improve ex- aminations, for providing the conditions for the phase II surgery. Results After the actively purpos- es I of surgery of 34 cases （34 eyes）, visual acuity of 10 cases had better recovery, not re-imple- mentation of the Phase II surgical treatment; 23 eyes received Phase II surgical treatment; only one heavier case of multi-site eye injury after phase I surgery had poor visual acuity, did not undergo the stage U surgical treatment. After surgical treatment of l and 1I, 29 cases （82.35% of all pa- tients） with visual acuity reached 0.01 -0.3, 28 eyes reached 0.4-0.6, accounted for 32.35% of all pa- tients. Conclusions Severe open eyeball rupture, regardless of the injured eye with no light percep- tion, should actively as soon as possible to do the purposes of emergency I of surgical treatment, postoperative strengthen anti-inflammatory, anti-infective, symptomatic and supportive therapy to pre- vent the occurrence of complications, to improve the inspection, and actively create conditions for the phase II surgery to save the eye, to restore visual function, and improve the different degree of vision, plays a key role.