在基层医院行白内障超声乳化术患者术中、术后并发症分析和处理

Analysis and Management of Intraoperative and Postoperative Complications of Patients with Cataract Phacoemulsification in Grassroots Hospitals

目的分析基层医院白内障超声乳化术患者术中术后并发症及不适症状的原因、特殊性及处理。方法回顾分析三年来在本院进行白内障超声乳化手术的患者85例(共124只眼),术后随访1~3个月不等,对患者术中、术后的主要并发症进行总结,分析产生的原因,在基层医院手术患者的特殊性,处理方法及效果。结果所有患者都顺利完成手术,患者术后视力明显提高,术后矫正视力大于0.6者91眼。术中并发症主要有:后囊膜破裂3眼,后弹力层部分脱离1眼,悬韧带部分断裂1眼,虹膜膨出破裂2眼。术后并发症主要有:角膜明显水肿5眼,眼压一过升高3眼,前葡萄膜炎2眼,眼内炎1眼,角膜炎3眼,术后顽固异物感4眼,反复眼痛2眼。所有并发症经过及时治疗后痊愈或减轻。结论白内障超声乳化及人工晶体植入术是一种创伤小、恢复快、术后视力提高明显的手术,在我国广泛开展,一些基层医院也逐渐普及,受到医生及患者的好评。但它同样是一项具有一定风险的手术,需要术者掌握熟练的技巧和具备丰富的临床经验。

Objective To analyze causes,specificity,and management of intraoperative and postoperative complications and discomfort symptoms of patients with cataract phacoemulsification in grassroots hospitals.Methods The paper reviewed and analyzed 85 patients(124 eyes)with cataract phacoemulsification surgery in our hospital over the past three years.Postoperative follow-up ranged from 1 to 3 months.The paper summarized main complications and discomfort symptoms during and after surgery,analyzed reasons for occurrence,characteristics of surgery in grassroots hospitals,treatment methods,and effect.Results All patients completed surgery successfully,and postoperative vision was significantly better.91 eyes had corrected vision higher than 0.6 after surgery.Main intraoperative complications include rupture of posterior capsule of 3 eyes,partial detachment of the posterior elastic layer of 1 eye,partial rupture of the suspensory ligament of 1 eye,and rupture of iris of 2 eyes.Main postoperative complications include significant corneal edeMA of 5 eyes,elevated intraocular pressure of 3 eyes,anterior uveitis of 2 eyes,endophthalmitis in 1 eye,keratitis of 3 eyes,persistent foreign body sensation of 4 eyes,and recurrent eye pain of 2 eyes.All complications were cured or alleviated after timely treatment.Conclusion Cataract phacoemulsification and intraocular lens implantation is invasive surgery wiht rapid recovery and significant improved postoperative vision,which has been widely carried out in China and gradually popularized in some grassroots hospitals with high praise from doctors and patients.But it has some certain risks,surgeons should master proficient skills and have rich clinical experience.At the same time,we noticed that complications of stubborn foreign body sensation and eye pain of patients in grassroots hospitals are relatively high,which may be related to relatively low trust of patients in hospitals and doctors.