显微镜下微创斜视矫正术与传统斜视矫正术治疗斜视的对比研究

Comparison of minimally invasive microscopic surgery and traditional surgery for strabismus

目的探讨显微镜下微创斜视矫正术与传统斜视矫正术治疗斜视的临床疗效及安全性。方法回顾接受眼科手术的斜视患者68例(108眼),其中传统组33例(53眼)接受肉眼下传统斜视矫正术,微创组35例(55眼)接受显微镜下微创斜视矫正术,术后随访6个月。以眼位矫正效果、术后疼痛情况、眼表状态变化、手术时间、术中出血量及并发症为观察指标。结果微创组眼位矫正治愈率(94.2%)较传统组(75.8%)高(P <0.05),微创组疼痛视觉模拟评分在术后2 h、1 d、7 d均低于传统组(P均<0.05)。微创组首次泪膜破裂时间在术后1 d、7 d较传统组缩短的少,泪河高度在术后1 d、7 d较传统组升高幅度小,眼红评分在术后1 d、7 d、30 d均低于传统组(P均<0.05)。2组平均手术时间差异无统计学意义(P> 0.05),微创组术中出血较传统组减少(P <0.05)。微创组随访未见并发症,传统组有3例术后出现结膜肉芽肿,2例手术切口明显瘢痕,2组比较差异均无统计学意义(P均> 0.05)。结论显微镜下微创斜视矫正术较传统斜视矫正术有明显的优越性,不仅创伤更小,疗效更好,而且对眼表的影响更小,疼痛更轻,外观更好,手术并发症更少。

Objective To investigate the efficacy and safety of minimally invasive strabismus surgery and traditional surgery in the treatment of strabismus. Methods Clinical data of 68 patients(108 eyes) with strabismus undergoing surgery were retrospectively analyzed. In the traditional group, 33 patients(53 eyes) received traditional strabismus surgery and 35 patients(55 eyes) in the minimally invasive group underwent minimally invasive microscopic strabismus surgery. All patients in both groups were followed up for 6 months after operation. The effect of strabismus correction, postoperative pain, changes in ocular surface status, operation time, intraoperative blood loss and complications were regarded as the observational parameters. Results The cure rate in the minimally invasive group was 94.2%, significantly higher than 75.8% in the traditional group(P < 0.05). The VAS pain scores at 2 h, 1 d and 7 d after operation in the minimally invasive group were significantly lower than those in the traditional group(all P < 0.05). In the minimally invasive group, the FTBUT at postoperative 1-and 7-d was significantly less, the increase of non-invasive tear meniscus height at postoperative 1-and 7-d was considerably smaller and the eye redness scores at 1-, 7-and 30-d after operation were remarkably lower than those in the traditional group, respectively(all P < 0.05). The average operation time did not significantly differ between two groups(P > 0.05). The intraoperative bleeding in the minimally invasive group was significantly less compared with that in the traditional group(P < 0.05). No complications were observed in the minimally invasive group, whereas 3 patients developed postoperative conjunctival granuloma and 2 cases presented with obvious scars on the surgical incision in the traditional group(both P > 0.05). Conclusions Minimally invasive microscopic strabismus surgery has obvious advantages over traditional strabismus surgery, which not only yields less trauma and higher efficacy, but also exerts less impact on the ocular surface, causes less pain, better cosmetic appearance and fewer surgical complications.