【摘要】 分析和探讨在表面麻醉下行小切口白内障摘除人工晶状体植入术在扶贫复明手术中的效果。方法：在表面麻醉下对183 例205眼白内障患者行小切口白内障摘除人工晶状体植入术，观察术中疼痛感、并发症、手术时间及术后视力。结果：手术过程中患者无痛感，能很好地配合手术，眼球固视好189眼(92.2%);术中偶感有轻度疼痛或异物感，可忍受并能配合手术顺利完成，或加滴表面麻醉药后能顺利完成手术者16眼(7.8%);183例 205眼平均手术时间22±7min;术中及术后各种并发症的发生率均很低。术后 1d视力：裸眼视力≤0.1者13眼(6.3%); 0.12～0.3者47眼(22.9%);0.4～0.8者126眼(61.5%);≥0.8者19眼(9.3%)，术后 1wk复查视力，视力≤0.1者4眼(2.0%);0.12～0.3者23眼(11.2%); 0.4～0.8者145眼(70.7%);≥0.8者33眼(16.1%)。结论：表面麻醉下小切口白内障囊外摘除人工晶状体植入术避免了相应的并发症，手术时间明显缩短，手术质量较好，因而适宜于大规模复明行动及基层医院开展以白内障为主的防盲治盲工作。
【关键词】 表面麻醉;小切口;白内障摘除术
Application of cataract extraction and intraocular lens implantation with small incision under topical anesthesia in poverty alleviation and cataract operations
YongHua Tang, YinBo Lu, XiangYong Xie
Department of Ophthalmology, the Affiliated Rui Kang Hospital of Guangxi TCM University,Nanning 530011, Guangxi Zhuang Autonomous Region,China
AbstractAIM: To analyse and discuss the effect of cataract extraction and intraocular lens implantation with small incision under topical anesthesia in poverty alleviation and cataract operations.
METHODS: A total of 183 cases 205 eyes with cataract were operated with cataract extraction and intraocular lens implantation with small incision under topical anesthesia.Their pain during the surgery, complications and their vision after the operation were observed.
RESULTS: The patients didn’t feel painful during the operation and cooperated well. There were 189 eyes 92.2% with good eyeball fixations 16 eyes (7.8%) with occasionally little pain or foreign body sensation of bearable level to cooperate the operation favorably，or need topical anesthetic to finish the operation; The mean operation time was 22±7 minutes; and the incidence rates of complications during and after the operation were both low. On 1 day after operation, the naked vision was≤0.1 in 13 eyes(6.3%); 0.120.3 in 47 eyes(22.9%); 0.40.8 in 126 eyes(61.5%); ≥0.8 in 19 eyes (9.3%). Rechecked in 1 week after the operation，the vision was≤0.1 in 4 eyes (2.0%); 0.120.3 in 23 eyes (11.2%); 0.40.8 in 145 eyes (70.7%); ≥0.8 in 33 eyes (16.1%).
CONCLUSION: The cataract extraction and intraocular lens implantation with small incision under superficial anesthesia can avoid homologous complications， reduce the operation time obviously and ensure better quality of operation. It’s suitable for largescale cataract operation actions and primary hospital to carry out the prevention and treatment of blindness in people with cataract.
KEYWORDS: topical anesthesia;small incision;cataract extraction
0引言
广西是白内障高发地区之一，目前由于部分地区经济条件和医疗技术条件较为落后，导致许多白内障患者看不起病、做不了手术，成为失明的主要原因。白内障复明工程在广西已经开展了多年，由于患者多、手术量大，选择一种低成本、手术时间短和质量稳定、安全的手术方式尤其重要。我们200601/200812在基层医院对183例205眼白内障患者采取表面麻醉下小切口白内障摘除人工晶状体植入术，效果满意，现将结果报告如下。
1对象和方法
1.1对象
收集200601/200812我们在基层医院进行扶贫白内障复明手术的病例183例205眼，男86例93眼，女97例112眼，年龄48～93(平均67.4±6.7)岁。其中，年龄相关性白内障患者145例162眼，并发性白内障20例20眼，糖尿病性白内障18例23眼。术前视力：光感～0.2。晶状体核硬度分级：I级核9眼，II级核42眼，III级核108眼，IV级核以上46眼。
1.2方法
术前用复方托吡卡胺或美多丽滴眼液充分散瞳。术前15min开始滴用倍诺喜滴眼液(4g/L盐酸奥布卡因滴眼液，日本参天制药株式会社)，每5min 1次，共3次。常规眼部消毒、铺手术巾，开睑器开睑后加滴1次倍诺喜滴眼液;于11∶00～1∶00位做以上穹隆为基底的结膜瓣，烧灼巩膜浅层毛细血管止血。用月形刀距角膜缘后界约2mm的巩膜上做6.0～6.5mm直线形或反眉形外切口，板层分离形成隧道，深度为巩膜厚度的1/2，前缘至透明角膜内1.0～1.5mm，用3.2mm的三角形切开刀于隧道前缘穿刺入前房。注入适量黏弹剂于前房内，用15°穿刺刀于2∶30位角膜缘作1mm辅助穿刺切口。利用截囊针行连续环形撕囊或开罐式截囊，充分水分离囊膜、皮质、核之间的联系。再注入适量黏弹剂，用黏弹剂注射器钝性针头拨动晶状体核的赤道部，使其上方1/3旋出囊袋伸入前房。前房、晶状体核与后囊膜注入黏弹剂，扩大隧道内口使其大于外口呈内长外短梯形口，舌状注水囊圈匙进入晶状体核与后囊膜之间，完整娩出晶状体核，注吸干净皮质，抛光后囊膜。前房注入适量黏弹剂充盈囊袋，囊袋内植入人工晶状体，如瞳孔较大，用卡米可林缩瞳;林格氏液注吸前房内残留皮质及黏弹剂，自辅助穿刺切口注入适量林格氏液，观察前房形成良好，检查切口无渗漏，切口不缝合。球结膜下注射抗菌药物，将上方球结膜覆盖于巩膜切口，包扎术眼。术后按常规给予氧氟沙星眼液加地塞米松滴眼液点眼，5 ～6次/d，复方托吡卡胺滴眼液点眼活动性散瞳。
2结果
2.1麻醉效果
麻醉效果分为3级。I级：手术过程中患者无痛感，能很好地配合手术，眼球固视好。II级：术中偶感有轻度疼痛或异物感，可忍受并能配合手术顺利完成，或加滴表面麻醉药后能顺利完成手术; III级：术中感疼痛，需加用球后或球周麻醉方可完成手术。结果：I级189眼(92.2%);II级16眼(7.8%);无1例因疼痛难忍而改为球后或球周麻醉。
2.2手术结果
所有183例205眼平均手术时间22±7min，有8眼在注吸皮质时后囊膜破裂，玻璃体脱出，均为开罐式撕囊者，在剪除前房内玻璃体后，6眼确认大部分前囊膜存在，顺利将人工晶状体植入睫状沟;2眼无法确认前囊膜放弃植入人工晶状体。15眼患者角膜水肿明显，加用500g/L葡萄糖眼液点眼，均在手术后 1wk左右消失。3眼发生前房少许出血，均来自切口，2～3d自行吸取。瞳孔变形7眼，但视力不受影响。术后未发生角膜失代偿等严重的并发症。术后1d视力：裸眼视力≤0.1者13眼(6.3%);0.12～0.3者47眼(22.9%);0.4～0.8者126眼(61.5%);≥0.8者19眼(9.3%)，术后1wk复查视力，视力≤0.1者4眼(2.0%);0.12～0.3者23眼(11.2%);0.4～0.8者145眼(70.7%);≥0.8者33眼(16.1%)。
[1] [2] 下一页 |
