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目的探讨马蹄形裂孔视网膜脱离玻璃体手术治疗的要点及其影响因素。方法回顾性研究玻璃体手术治疗马蹄形裂孔视网膜脱离患者110例(110眼)的临床结果,对术中处理裂孔边缘粘连牵引、重水应用、气液交换吸出网膜下液、激光或冷凝封闭裂孔、惰性气体充填等技术进行分析和比较性研究。结果1.行施玻璃体手术后裂孔封闭视网膜脱离复位一次性成功者共93例(84.6%)。其中5例因裂孔封闭不全随即再次手术治愈。12例在随访中发现有新裂孔形成,视网膜再脱离,7例接受再次手术治愈。2例激光光凝治愈。2.术中42例用重水压平视网膜行裂孔边缘处膜切除,其中35例治愈(83.3%);68例直接行膜切除松解牵引灶,其中58例治愈(85.3%)。二者无统计学差异(x2=0.072P>0.05)。3.在裂孔处行气液交换内放液,其中47例全气液交换40例治愈(85.1%);63例行部分气液交换以裂孔贴附为准,其中53例治愈(84.1%)。二者无统计学差异(x2=0.13P>0.05)。4.气液交换后用激光封闭裂孔34例,其中24例治愈(70.58%),用巩膜外冷凝法76例,其中69例治愈(90.78%)。二者相比冷凝的效果好(x2=5.48P<0.05)。结论马蹄形裂孔视网膜脱离采用玻璃体手术重点在切除裂孔边缘粘连牵引,应用重水和气液交换以裂孔贴附为度。冷凝比激光封闭的效果要好。
Objective To investigate the main points of vitreous surgery for retinal detachment with horseshoe fractures and its influencing factors. Methods The clinical results of 110 patients with horseshoe lobed retinal detachment who underwent vitrectomy were retrospectively analyzed. The intraoperative effects of adhesion and traction on the edge of the hiatus, application of heavy water, aspiration of subretinal fluid by gas-liquid exchange, laser or condensation of closed pores, inertness Gas filling technology analysis and comparative research. Results 1. Vitreous hilar surgery after retinal detachment closed one-off successful a total of 93 cases (84.6%). 5 cases of which were closed again due to incomplete closure of the hole. Twelve cases were found in the follow-up of new crack formation, re-detachment of the retina, 7 patients underwent reoperation. 2 cases of laser photocoagulation cure. In 42 cases, resection was performed on the edge of the hole with heavy water pressure flat retina, of which 35 cases were cured (83.3%). 68 cases were directly treated by membrane excision and release traction, of which 58 cases were cured (85.3%). There was no significant difference between the two groups (x2 = 0.072P> 0.05). In the gas-liquid exchange at the foramina, 40 cases were cured (85.1%), and the partial gas-liquid exchange was performed in 63 cases, of which 53 cases were cured (84.1%), . There was no significant difference between them (x2 = 0.13P> 0.05). After the gas-liquid exchange, 34 cases were closed with laser, of which 24 cases were cured (70.58%), 76 cases were scleral condensation, of which 69 cases were cured (90.78%). Condensation was better than both (x2 = 5.48P <0.05). Conclusion Horseshoe-shaped retinal detachment using vitreous surgery focused on the edge of the removal of adhesions and traction traction, application of heavy water and gas-liquid exchange in order to crack the hole for the degree. Condensation is better than laser sealing.