新鮮羊膜在兒童共同性斜視縫線調(diào)整顯微手術(shù)中的應(yīng)用

譚葉輝，廖　武，曾廣川，何　歡，謝仁藝，葉陽君

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新鮮羊膜在兒童共同性斜視縫線調(diào)整顯微手術(shù)中的應(yīng)用

譚葉輝1，廖武1，曾廣川1，何歡2，謝仁藝2，葉陽君1

?METHODS: With the clinical randomized control study (RCT), 60 (112 eyes) cases of patients in childhood who received microscopic strabismus surgery in our hospital were divided them into two different groups from Jan.2010 to Oct.2015. According to the application of AM on the basis of ophthalmology outpatient number, 30 cases (58 eyes) in group A were treated with rectus muscle recession surgery combined adjustable suture combined with AM. The other 30 cases (54 eyes) in group B were treated with rectus muscle recession surgery combined adjustable suture only. All patients in two groups were followed-up over 6mo after the strabismus surgery.

?RESULTS:Twenty-seven cases (48 eyes) of all the strabismus patients must be adjusted after strabismus surgery, and the eye position adjustment rate was 42.9%. At 1mo after surgery, eye position of 18 cases (29 eyes) can be adjusted in all patients, and 44.8% (16 cases, 26 eyes) in group A with the average of adjustment lengths was 2.56±0.64mm, and 5.6% (2 cases, 3 eyes) in group B, with the average of adjustment lengths was 0.52±0.28mm, the differences of the adjustment rate and the average of adjustment amount were both high statistically significant (χ2=22.477,P<0.01;t=16.502,P<0.01) between the two groups. Except of 3 cases who couldn’t cooperate with eye position adjustment, they all received eye position adjustment in different degrees in one month after strabismus surgery,and after eye position adjustment, 27 cases (53 eyes) in group A got normal eye position, and the correction rate of eye position was 91.4%, and 16 cases (28 eyes) in group B got normal eye position after eye position adjustment, the correction rate was 51.9%, the differences of the correction rate were statistically significant (χ2=21.827,P<0.01) between the two groups.

?CONCLUSION: The application of fresh AM in the microscopic adjustable suture strabismus surgery is exactly effective in treatment of children’s intercommunity strabismus. It can significantly extend the adjustment time and increase the adjustment amount, and it also can statistically improve the controllability and achievement ratio for children’s strabismus surgery.

目的：探討新鮮羊膜在兒童共同性斜視縫線調(diào)整顯微手術(shù)中的應(yīng)用療效，為臨床治療提供指導(dǎo)。

方法：應(yīng)用臨床隨機(jī)對照研究方法，依據(jù)眼科門診就診號將 2010-01/2015-10在我科住院并行顯微斜視矯正術(shù)的60例112眼兒童共同性斜視患者平均分為兩組，A組30例58眼行直肌后徙縫線調(diào)整聯(lián)合羊膜移植術(shù), B組30例54眼行單純直肌后徙縫線調(diào)整術(shù)，斜視矯正術(shù)后隨訪均≥6mo。

結(jié)果：斜視患者27例48眼術(shù)后眼位需調(diào)整，眼位需調(diào)整率為42.9%。術(shù)后1mo，眼位可調(diào)整18例29眼，其中A組16例26眼，眼位可調(diào)整率為44.8%，眼位可調(diào)整量平均為2.56±0.64mm；B組2例3眼，眼位可調(diào)整率為5.6%，眼位可調(diào)整量平均為0.52±0.28mm，兩組比較眼位可調(diào)整率及可調(diào)整量差異均有統(tǒng)計(jì)學(xué)意義(χ2=22.477，P<0.01；t=16.502，P<0.01)。除3例患兒術(shù)后不配合眼位調(diào)整外，其余均在術(shù)后1mo內(nèi)行不同程度的眼位調(diào)整，眼位調(diào)整后，A組27例53眼眼位正位，正位率為91.4%, B組16例28眼眼位正位，正位率為51.9%，兩組比較斜視術(shù)后正位率差異有統(tǒng)計(jì)學(xué)意義(χ2=21.827，P<0.01)。

結(jié)論：在兒童共同性斜視縫線調(diào)整顯微手術(shù)過程中應(yīng)用新鮮羊膜效果確切,可明顯延長眼位調(diào)整時(shí)間及增加眼位調(diào)整量，提高了兒童斜視手術(shù)的可控性和成功率。

羊膜；兒童；共同性斜視；縫線調(diào)整術(shù)

引用：譚葉輝，廖武，曾廣川，等.新鮮羊膜在兒童共同性斜視縫線調(diào)整顯微手術(shù)中的應(yīng)用.國際眼科雜志2016;16(11):2166-2168

0　引言

共同性斜視是兒童斜視最常見的類型，而且有逐年上升趨勢，嚴(yán)重時(shí)可導(dǎo)致功能性失明[1]，早期行顯微斜視矯正術(shù)是目前公認(rèn)的兒童斜視最有效的治療方法之一[2]，但兒童斜視矯正手術(shù)，因其特殊的生理特點(diǎn)，絕大多……