初始3000例超声乳化白内障手术中后囊破裂的临床分析

Posterior capsule rupture in the first 3000 cases of phacoemulsification cataract surgery for doctor just finished training

目的分析系统培训医生全程独立完成的前3000例超声乳化白内障吸除手术中, 后囊破裂(PCR)的发生时期、原因及处理方法。方法回顾性收集同一术者全程独立完成的初始3 000例超声乳化术中发生的PCR病例, 统计并分析其发生时期、发生原因及处理结果。结果 3 000例中发生后囊破裂共37例(1.2%)。37例中, 在早、中、晚各1000例手术时期中的后囊破裂发生率分别为2.5%、0.9%、0.3%;发生在注吸皮质时20例, 占37例中的54%, 超乳核块时6例, 人工晶状体植入时2例, 吸出人工晶状体后方黏弹剂时2例, 前囊撕裂导致后囊破裂2例, 后囊抛光时1例, 人工晶状体调位时1例, 注入黏弹剂时1例, 水密切口时1例, 不明原因的1例;伴随玻璃体脱出者33例, 无玻璃体脱出者4例;人工晶状体植入睫状沟32例, 囊袋内5例。结论全程独立完成的初始3 000例白内障超声乳化手术中, PCR在前1 000例手术初期中出现的发生率最高;PCR可发生在手术的任何步骤, 但以注吸皮质时发生率最高。经过系统培训后能及时发现并发症, 规范操作, 使并发症处理的相对容易。

Objective To analyze the occurrence of posterior capsule rupture(PCR)in the first 3000 cases of phacoemulsification cataract extraction(PCE)and posterior chamber IOL(PO-IOL)surgery for doctor just finished training.Methods Retrospectively analyzed the data of PCR occurred in the first independently completed 3000 cases of PCE and PC-IOL surgery.Results 37 cases(1.2%)of posterior capsule rupture occurred,the incidences in early,middle and late 1000 cases of the surgery were 2.5%,0.9%and 0.3%.20 cases of PCR occurred in inhaling the cortex,6 cases when phaco nuclear block,2 cases in lens implantation,2 cases when inhaling the lens rear,former capsule tearing caused 2 cases,1 case in polishing,position adjustment,injecting visco,watertight incision and unknown,respectively.Conclusions PCR during PCE and PC-IOL has the highest incidence in the first 1000 cases of surgery,it can occur at any step of the operation,but the procedure with highest incidence is in inhaling the cortex of lens.