【摘要】 目的:探讨在玻璃体手术中应用前房维持器行眼内灌注的可行性。方法:实验组：一些眼球穿通伤患者如外伤性白内障合并有眼后段异物或眼后段损伤(如玻璃体混浊、出血)，经前房维持器行眼内灌注做白内障摘除与玻璃体切除联合术，共20眼。标准对照组：行传统睫状体平坦部三切口闭合式玻璃体切除术的患者，共20眼。术中的玻璃体切割器均设定切割率为540次/min， 抽吸力为150mmHg，测出术中灌注瓶高度分别在65cm时和在70cm时各眼的单纯抽吸状态下灌注速率、抽吸与切割状态下灌注速率;拔出玻璃体切除头和光导纤维，用巩膜钉封闭颞上方、鼻上方巩膜切口，测出术中灌注瓶高度分别在65cm时和在70cm时各眼的眼压。结果:灌注瓶高度为65cm时两组的单纯抽吸状态下灌注速率比较P=0.36、两组的抽吸与切割状态下灌注速率比较P=0.31;灌注瓶高度为70cm时两组的单纯抽吸状态下灌注速率比较P=0.13、两组的抽吸与切割状态下灌注速率差异比较P=0.18;灌注瓶高度为65cm时两组眼压比较P=0.56;灌注瓶高度为70cm时两组眼压比较P=0.45。结论:在一些眼球穿通伤患者如外伤性白内障合并有眼后段异物或眼后段损伤(如玻璃体混浊、出血)的玻璃体手术中使用前房维持器行眼内液体灌注是可行的。
【关键词】 玻璃体手术;前房维持器;灌注套管
Comparison of the infusing B.S.S. using anterior chamber maintainer and infusing ductus in operation on vitreousXiaoBo Wan, XiaoMei Zhang, Yong Liang1Department of Ophthalmology, the Peoples Hospital of Liuzhou City, Liuzhou 545000, Guangxi Zhuang Autonomous Region,China; 2 Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,ChinaAbstractAIM: To evaluate the feasibility of using anterior chamber maintainer in operation on vitreous.THODS: Experimental group: 20 eyeballs that had the penetrating injury, like traumatic cataract that combined with the eyeposterior trauma taken the cataract extraction associated the operation on vitreous. In this surgery the anterior chamber maintainer was used to infuse B.S.S; control group: there were 20 eyeballs that taken the the par plana vitrectomy. In this surgery the infusing ductus fixed in the incision of the sclera was used to infuse B.S.S., and the cutter rate was setted to 540 times per min and the aspirations suction was setted to 150mmHg in vitreous cutter of every operation on vitreous. When the bottle height was 65cm and 70cm, the infusing rate under the state of aspiration or under the state of aspiration and excision of each eye were measured. The vitrectomy head and optical fiber were pulled out, closing the temples side with sclera nails, performing scleral incision above nose, measuring intraocular pressure in each eye when the infusion bottle height was 65cm or 70cm.RESULTS: When the infusion bottle height was 65cm, infusion rate was compared under the state of aspiration (P=0.36), and under the state of aspiration and excision(P= 0.31); when the infusion bottle height was 70cm, infusion rate was compared under the state of aspiration (P=0.13), and under the state of aspiration and excision(P=0.18);intraocular pressures between the two groups were compared when the infusion bottle height was 65cm(P=0.56), and when the infusion bottle height was 70cm(P=0.45).
CONCLUSION: The use of the anterior chamber maintainer for infusing B.S.S in operation on vitreous is feasible.
KEYWORDS: operation on vitreous; anterior chamber maintainer; infusing ductus
0引言
自1980年Blaydes[12]报道了前房持维器(anterior chamber maintainer，ACM)在白内障手术中的应用以来，ACM在眼科手术中的应用越来越广泛如用于白内障囊外摘除术[3]、白内障超声乳化术[4,5]，此外前房维持器也可用于半脱位晶状体摘除术[6]、暴发性脉络膜上腔出血的手术治疗[7]、无晶状体或人工晶状体性青光眼的手术中[8,9]。目前前房维持器主要应用于眼前段手术中控制前房的深度及眼内压，它应用于玻璃体手术的研究在国内外期刊上报道较少。我们对前房维持器与巩膜切口灌注套管在玻璃体手术中行眼内灌注的比较，目的是研究经前房维持器的眼内灌注液体能否达到玻璃体手术对液体灌注状态的要求 ，能否简化玻璃体手术的操作。
1对象和方法
1.1对象
试验眼选自200410/200604收住广西医科大学眼科中心的患者38例，其中36例单眼发病，2例双眼发病，共40眼。试验组眼：一些眼球穿通伤患者如外伤性白内障合并有眼后段异物或眼后段损伤(如玻璃体混浊、出血)，采用经前房维持器行眼内灌注做白内障摘除与玻璃体切除联合术，共20例，均为单眼发病，男18例，女2例，年龄3～60(平均45)岁。标准对照组眼：行传统睫状体平坦部三切口闭合式玻璃体切除术(par plana vitrectomy，PPV)的患者，术中采用经睫状体平坦部巩膜切口的灌注套管行眼内灌注,共18例，20眼， 16例为单眼发病，2例为双眼发病，男15例，女1例，年龄8～57(平均47)岁。ACM的直针腔管是一个前端为30°～40°斜面，直针管长4mm，外径0.8mm，内径0.6mm(图1)。灌注套管的直针管长4mm，外径0.8mm，内径0.6mm(图2)。设备：(1)眼科手术显微镜及显微器械;(2)玻璃体切割机(STORZ);(3)前房维持器与灌注套管;(4)Schiotz眼压计。
1.2方法
灌注速率的测定：测定一次从ACM或灌注套管的灌注头导出的BSS体积，导出时间1min，将每分钟导出的BSS毫升数作为灌注速率。我们把术眼到灌注瓶液体平面的高度设为65cm或70cm，测出玻璃体切割器在单纯抽吸状态时及在抽吸与切割状态时的灌注速率。眼压的测量：采用Schiotz眼压计双砝码对读法，均测量3次，取其平均值。试验组：患眼拟行白内障摘除与玻璃体切除联合术，先在术眼的颞下方角膜周边部用矛形宝石穿刺刀做前房穿刺口，然后经前房穿刺口插入前房维持器，用来做眼内液体的灌注(图3)。白内障摘除后，在术眼颞上方、鼻上方睫状体平坦部做巩膜切口作为光导纤维进出切口和玻璃体切除头进出切口，通过上述三个切口做闭合式玻璃体手术，把玻璃体切割器设定切割率为540次/min， 抽吸力为150mmHg，分别测出术中灌注瓶高度在65cm时和在70cm时每眼的单纯抽吸状态灌注速率、抽吸与切割状态灌注速率;拔出玻璃体切除头和光导纤维，用巩膜钉封闭颞上方、鼻上方巩膜切口，分别测出术中灌注瓶高度在65cm时和在70cm时每眼的眼内压;实验标准对照组：患眼拟行传统闭合式的玻璃体切除术，先在术眼的颞上方、鼻上方、颞下方睫状体平坦部做三个巩膜切口，用颞下方的巩膜切口安置灌注套管作眼内灌注(图4)，颞上方、鼻上方的巩膜切口作为光导纤维进出切口和玻璃体切除头进出切口，通过上述三个切口行闭合式玻璃体手术，把玻璃体切割器设定切割率为540次/min， 抽吸力为150mmHg[10]，分别测出术中灌注瓶高度在65cm时和在70cm时每眼的单纯抽吸状态灌注速率、抽吸与切割状态灌注速率;拔出玻璃体切除头和光导纤维，用巩膜钉封闭颞上方、鼻上方巩膜切口，分别测出术中灌注瓶高度在65cm时和在70cm时每眼的眼内压。
统计学分析：实验数据以均数±标准差表示，组间比较采用方差分析。所有数据均以统计分析软件包SPSS 11.0进行分析。
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