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目的探讨外路法视网膜脱离复位手术中改良穿刺放视网膜下液的临床有效性及安全性。设计回顾性病例系列。研究对象2006年1月至2009年9月收住南京医科大学第一附属医院眼科的329例孔源性视网膜脱离的患者。方法手术显微镜下予巩膜环扎和(或)巩膜外加压术,术中均联合改良穿刺法放出视网膜下液,即穿刺点选在角巩膜缘后11 mm的直肌两侧,避开涡状静脉和视网膜裂孔,采用25 G 5/8-in针头(1ml BD针头,新加坡Becton Dickinson Medical(S)Pte Ltd.)垂直巩膜穿刺放出视网膜下液,穿刺深度不超过针头斜面。收集术前、术后及手术数据并进行分析。主要指标改良穿刺放液的成功率及并发症的发生率。结果 329例外路法视网膜脱离复位手术,327例(99.4%)引流出视网膜下液,2例未引流出视网膜下液。改良穿刺放液的并发症有视网膜下岀血2例(0.6%),出血范围小于2PD,穿刺点正对视网膜裂孔处1例(0.3%),导致玻璃体自巩膜穿剌口脱出。结论改良穿刺放液法是外路法视网膜脱离复位术中引流视网膜下液的一种安全、有效的方法。
Objective To investigate the clinical efficacy and safety of modified subpleural subretinal fluid in repositioning retinal detachment surgery. Design retrospective case series. Subjects From January 2006 to September 2009 admitted to the First Affiliated Hospital of Nanjing Medical University, 329 cases of rhegmatogenous retinal detachment patients. Methods Surgical scleral buckling and / or scleral buckling were performed under the operation microscope. Subretinal fluid was released during the operation with modified puncture. The puncture point was selected on both sides of the rectus muscle 11 mm behind the sclera limbus to avoid the vortex Ventral retinal detachment was performed using a 25 G 5/8-in needle (1 ml BD needle, Becton Dickinson Medical (S) Pte Ltd., Singapore) punctured to a depth no greater than the needle bevel. Preoperative, postoperative and surgical data were collected and analyzed. The main indicators improved the success rate of puncture and discharge and the incidence of complications. Results 329 cases of extra-retinal detachment surgery, 327 cases (99.4%) drainage of the subretinal fluid, 2 cases did not drain out of the subretinal fluid. The complications of modified puncture and draining were 2 cases (0.6%) with subretinal hemoptysis, the bleeding range was less than 2PD, and 1 point (0.3%) puncture point was at the retinal hole, which led to the prolapse of the vitreous sclera through the puncture hole. Conclusion Improved puncture and draining method is a safe and effective method for drainage of subretinal fluid during the removal of retinal detachment.