27G微创玻璃体切除手术的发展及应用

Progress and application of 27-gauge micro-incision vitrectomy

自二十世纪初25G、23G无缝线玻璃体切除术的相继推出,已将我们带入玻璃体视网膜手术的微创时代约有10余年历史。与传统20G三通道玻璃体切除术相比,25G、23G无缝线微创玻璃体切除术不仅缩小巩膜切口,而且还大大简化了手术程序,缩短了手术时间及降低了手术并发症。因此,在过去十余年时间里,越来越多的医生由传统的20G玻璃体切除术转向25G、23G玻璃体切除术。但随着微创玻璃体切除术的普及,无缝线巩膜切口的相关并发症也随之增多。本着"越小越好"的理念,眼科学者开始研究下一代玻切手术,并且得益于不断更新换代的高速玻切机、高通量的照明光源、更精细的制造技术和清晰广角镜的发展,日本学者Oshima于2010年正式推出了27G玻璃体切除术。27G玻璃体切除术较之前的微创玻璃体切除术切口更小,切割速率更高,带给眼底外科医生全新的体验。目前27G甚至更细的玻璃体切除术尚处在继续革新之中,围绕其优缺点、适应证及未来发展也逐渐成为大家关注讨论的焦点。本文在此结合笔者27G玻璃体切除术经验,对27G微创玻璃体切除术玻璃体切除术进行了一个简要的综述。

Since the introduction of 25-gauge /23-gauge（ 25 G /23G） sutureless m icro-incision vitrectom y surgery（ MIVS） at the beginning of the 21 century,we have stepped into an era of m icro-incision vitreoretinal surgery m ore than10 a. The current 25 /23 G MIVS provide num erous advantages over the conventional 20 G vitrectom y surgery including sim plified surgical procedure, shortened operating tim e, decreased com plications as well as sm aller sclerotom y wound. As a result,vitreoretinal surgeons have been shifting gradually from 20-gauge to 25 /23-gauge vitrectom y in the past decade. As the 25 /23 G MIVS adapted worldwide,however,its drawbacks were also increasingly reported.Most criticism regarding to current 25 /23 G MIVS are focusing on would sealing related com plications. Based on stablished notion regarding vitrectom y-＂the sm aller the better ＂, researchers and doctors were keeping on exploring the next generation of vitrectom y system.Thanks to the innovation and developm ent in newgeneration vitrectom y m achines,high lum en output light source,m ore delicate m anufacturing technology and clearwild angle fundus viewsystem,Dr. Oshim a from Japan launched the first 27-gauge vitrectom y surgery system. It provided us novel surgical experience with sm aller sclerotom y wound and faster cut rate. Further developm ent and refinem ent of vitrectom y with 27-gauge or m ore are still on its way and will continue in the future.Undoubtedly,MIVS would be heated debated regarding its pro / con, com plications, indications and future developm ent. Com bined with our own experiences,here we briefly reviewed the 27-gauge vitrectomy surgery.