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目的评估四切口双手操作进行复杂性玻璃体切割手术治疗严重玻璃体视网膜病变的临床效果。设计回顾性病例系列。研究对象39例(39眼)复杂性玻璃体视网膜病变患者。方法对以上患者行助手照明、四切口双手操作法玻璃体切割手术,切除机化玻璃体和积血、剥除增生膜或取出异物、复位视网膜。术后随访6～18个月,观察视力,视网膜复位情况等。主要指标手术时间,手术前后患眼视力,术中、术后并发症。结果 39眼术中顺利切除机化玻璃体,剥离视网膜增生膜,剥膜时间4～50min(平均16.2min),取出异物,复位视网膜,手术时间32～65min(平均48min)。术后1个月随访时,视力明显提高者35眼(视力表提高2行或者光感到指数),随访中4眼再次发生视网膜脱离,2眼视网膜出血。39例术中及术后随访期内均未发生明显并发症。结论四切口双手操作玻璃体切割手术容易进行剥膜、取异物等操作,对复杂性玻璃体手术有较大的临床应用前景。
Objective To evaluate the clinical effect of four-incision two-handed operation for complicated vitreoretinal surgery in patients with severe vitreoretinopathy. Design retrospective case series. Subjects 39 patients (39 eyes) complicated with vitreoretinopathy patients. Methods The above patients underwent assistant illumination, four-incision two-handed operation of vitrectomy, resection of the vitreous and hematoma, removal of proliferative or removal of foreign body, the retina was reset. Follow-up 6 to 18 months after surgery, visual acuity, retinal reattachment and so on. The main indicators of operation time, preoperative and postoperative eye vision, intraoperative and postoperative complications. Results 39 eyes were removed with vitrectomy and the retinal proliferating membrane was stripped. The time of stripping was 4 to 50 minutes (average 16.2 minutes). The foreign body was removed and the retina was removed. The operation time was 32 to 65 minutes (mean 48 minutes). At 1 month follow-up, 35 eyes with marked improvement of visual acuity (eyesight increased by 2 lines or light felt index), retinal detachment occurred again in 4 eyes and 2 eyes had retinal hemorrhage. There were no obvious complications in 39 cases and during the follow-up period. Conclusion Four-incision operation with vitrectomy is easy to remove the membrane and take foreign bodies. It has great clinical application prospect for complex vitreous surgery.