23G与20G玻璃体切割系统在硅油取出术中的对比研究

Comparison of 23G and 20G vitreous cut system in silicone oil extracting operation

目的：比较23G与20G玻璃体切割系统在硅油取出手术的安全性和有效性。方法：选取2013-01/2015-06我科98例98眼硅油充填术后3~6mo视网膜附着稳定,适合取硅油的患者,按照随机数字表随机分为两组,20G玻璃体切割系统组48例48眼,23G玻璃体切割系统组50例50眼。对两组建立及关闭通道时间,取油时间;术前,术后1、3d,1wk,3、6mo眼压,术前、术后末次随访时最佳矫正视力;术后1、3d,1mo眼前节炎症反应比较分析;观察术中、术后并发症发生情况。结果：20G组与23G组建立手术通道时间为243.54±51.17,91.16±21.37s;关闭切口时间为235.04±42.89,86.04±21.76s;取油时间6.7±1.65,7.35±2.02min,两组在建立手术通道时间及关闭切口时间差异有统计学意义（P〈0.01）,两组在取油时间没有统计学意义（P〉0.05）。20G组与23G组术后1d眼压比较有统计学意义（P〈0.05）,其余时间点眼压比较无统计学意义（P〉0.05）。20G组与23G组术前及术后6mo最佳矫正视力分别为：4.21±0.61,3.91±0.64;4.03±0.46,4.22±0.39,比较无统计学意义（P〉0.05）。20G组术后1、3d前房细胞与23G组比较有统计学意义（P〈0.05）,术后1mo比较则无统计学意义（P〉0.05）。20G及23G组术中均未发生并发症,术后23G组出现暂时性低眼压5眼,视网膜再脱离1眼,脉络膜脱离1眼,20G组出现暂时性低眼压1眼,视网膜脱离3眼,脉络膜脱离2眼。结论：23G玻璃体切割系统具有手术步骤少、术中损伤小、术后并发症发生几率低等优点,应用于硅油取出术安全、有效。

AIM： To evaluate the safety and effectiveness of 23G and 20G vitreous cutting system in silicone oil extracting operation. ●METHODS：A total of 98 cases （98 eyes） patients, after 3- 6mo silicone oil filling with retinal attachment and suitable for retrieving silicone oil. Patients were randomly divided into two groups. 20G vitreous cutting system group including 48 cases （ 48 eyes ） and 23G vitreous cutting system group including 50 cases （ 50 eyes ） . A series of comparative analyses were conducted on the times for set up and closing the passage and the time for taking the oil time on the two groups：intraocular pressure of preoperative and of postoperative for 1, 3d, 1wk, 3 and 6mo. The comparisons were also made between the best corrected visual acuity of preoperative and postoperative. The section inflammation of postoperative 1, 3d, 1mo were compared. Complications were compared between intraoperative and postoperative. ●RESULTS：Establishing surgery channel for 20G and 23G group were （ 243. 54 ± 51. 17 ） s and （ 91. 16 ± 21. 37 ） s respectively;closing wound time were （235. 04 ± 42. 89） s and （86. 04±21. 76）s. Extracting oil time were （6. 7±1. 65） min and （ 7. 35 ± 2. 02 ） min. There was a significant difference （ P〈0. 01 ） between establishing the operation channel time and close the incision time. There was no significant difference between two groups in the extracting oil time （P〉0. 05）. The first day was statistically different （ P〈 0. 05 ） but the rest of the time point of intraocular pressure had no statistical difference （ P 〉0. 05）. The best corrected visual acuity for 20G and 23G group preoperative and postoperative after 6mo were：4. 21 ± 0. 61, 3. 91 ± 0. 64; 4. 03 ± 0. 46 and 4. 22 ± 0. 39 respectively. There was no significant difference between the two groups （P〉0. 05）. There was significant difference （ P〈0. 05） of cells in the anterior chamber between the 20G group and 23G group of postoperative 1 and 3d. There was no statistical difference after 1mo （P〉0. 05）. The findings also reported that 20G and 23G group had no intraoperative complications and postoperative. For 23G group, 5 cases of temporarily had lower intraocular pressure, 1 case was retinal again, 1 case was choroid detachment. For 20G group, 1 case of temporarily had lower intraocular pressure, 3 cases were retinal detachment and 2 cases were choroid detachment. ●CONCLUSION：23G vitreous cutting system has the advantages of low operation steps, intraoperative injury. The postoperative complications of low probability, used in silicone oil is safe and effective.