手术方式和术后眼位对间歇性外斜视患者生活质量的影响

The effect of surgical methods and postoperative eye position on the quality of life in patients with intermittent exotropia

目的评估术后3个月不同的手术方式、术后眼位对间歇性外斜视（IXT）患者及其家长生活质量的影响。 方法回顾性系列病例研究。共招募180例行斜视手术的IXT患者（2~17岁）。对每位患者的一位家长分别于术前1周内、术后3个月采用2种中文版间歇性外斜视生活质量评估量表（CIXTQ）进行调查，即家长代理量表[用于家长评估儿童的生活质量（HRQoL）]和家长量表（用于家长评估自身的生活质量HRQoL）。根据手术方式分为单眼手术组（58例）与双眼手术组（122例）。根据术后3个月的眼位分为欠矫组（24例）、成功组（135例）、过矫组（21例）。分析：（1）手术前后CIXTQ量表得分的差异；（2）不同手术方式手术前后CIXTQ量表得分的差异；（3）不同术后眼位手术前后CIXTQ量表得分的差异。 结果术后3个月时，家长代理量表、家长量表的功能、社会心理及手术维度的得分分别为（79.42±23.00）、（55.18±25.63）、（65.27±29.16）、（51.44±28.71）分，相比术前（66.61±25.25）、（37.21±22.28）、（47.60±27.13）、（28.02±24.47）、（40.66±22.82）分，差异有统计学意义（t=-9.585，-11.361，-10.856，-11.622；P〈0.001）。单眼手术组家长代理量表、家长量表的功能、社会心理及手术维度的得分分别为（13.79±17.53）、（19.04±17.87）、（19.73±22.97）、（23.71±29.40）分，双眼手术组分别为（13.07±18.94）、（17.47±22.70）、（16.98±21.57）、（23.67±26.25分，差异无统计学意义（t=0.242，0.462，0.781，0.009；P〉0.05）。欠矫组家长代理量表、家长量表的功能、社会心理及手术维度的得分分别为（19.27±15.40）、（23.70±13.91）、（20.92±10.59）、（28.65±23.16）分，成功组分别为（16.40±19.94）、（22.72±18.32）、（22.38±19.51）、（28.52±24.61）分，过矫组分别为（-12.20±17.64）、（-20.68±20.00）、（-19.56±27.26）、（-16.07±20.97）分，差异有统计学意义（F=21.527，54.236，41.784，31.943；P〈0.001）。与术前相比，术后欠矫组与成功组家长代理量表及家长量表3个维度的得分均明显提高，差异具有统计学意义（t=-13.639^-6.059，P〈0.05），而过矫组的得分明显下降，差异具有统计学意义（t=1.350~4.391，P〈0.05）。 结论术后3个月时，不同手术方式对术后IXT患者及其家长生活质量无明显影响；术后眼位明显影响术后IXT患者及其家长的生活质量，欠矫或成功均能明显提高生活质量，而过矫却明显降低生活质量。

Objective To evaluate the effects of different surgical methods and postoperative eye positions on the quality of life of children with intermittent exotropia （IXT） and their parents 3 months following strabismus surgery. Methods Clinical observation. One-hundred and eighty children aged 2 to 17 years with IXT who received surgical treatment were recruited. One parent of each child was investigated by using 2 kinds of the Chinese version of the Intermittent Exotropia Questionnaires （CIXTQ） within 1 weeks before and at 3 months after surgery： the parent proxy scale （ for parents to assess children＇s health related quality of life （HRQoL）） and the parent scale （containing functional, psychosocial and surgery subscales ; for parents to assess their HRQoL）. One hundred and eighty children were divided into different groupsaccording to the surgical. Methods Monocular surgery group, binocular surgery group and eye position after 3 months： undercorrection group, successful group, overcorrection group, to explore： （1） the change of scores before and after surgery. （2） the difference of score changes after surgery between monocular and binocular surgery groups. （3） the difference of score changes after surgery between different postoperative eye position groups. Results Significant improvement in median scores was seen from pre-operation to 3months post-operatively for all the proxy scale （t=-9.585, P〈0.001）, the functional （t=-11.361, P〈0.001）, psychosocial （t=-10.856, P〈0.001） and surgery subscale （t=-11.622, P〈 0.001） of parent scale. The change values from pre-operation to 3months post-operatively were not significantly different between monocular and binocular surgery groups for all the proxy scale （t=0.242, P=0.330）, the functional （t=0.462, P=0.050）, psychosocial （t=0.781, P=0.582） and surgery subscale （t=0.009, P=0.355） of parent scale, but significantly different between undercorrection, successful and overcorrection groups for the proxy scale （F=21.527, P〈 0.001）, the functional （F=54.236, P〈0.001）, psychosocial （F=41.784, P〈0.001） and surgery subscale （F= 31.943, P〈0.001）. The scores of proxy scale and 3 parent subscales were all significantly improved （t=-13.639 to-6.059, P〈0.05） after operation in both the undercorrection and successful groups, while significantly decreased in the overcorrection group （t=1.350---4.391, P〈0.05）. Conclusions HRQoL can be improved significantly in both the undercorrection and successful groups, while decreased in the overcorrection group.