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眼眶减压术中深部眶外侧壁的祛除:有益于眼球突出复位及其对持续性复视的影响

世界核心医学期刊文摘(眼科学分册) 2006年第2期 17-18页

作者： baldeschi l.macandie k Hintschich C. 桑延智 Department o f Ophthalmology Academic Medical Center University of Amsterdam Meiber-gdreef 91105 AZ Amsterdam Netherlands Dr.

PURPOSE: To evaluate the contribution of maximal removal of the deep lateral wall of the orbit to exophthalmos reduction in Graves orbitopathy and its influence on the onset of consecutive diplopia. DESIGN: Case-control study. METHODS: The medical records of two cohorts of patients affected by Graves orbitopathy with exophthalmos lopia, were retrieved at random from the pool of patients decompressed for rehabilitative reasons at our institution (01/1990 to 12/2003), and retrospectively reviewed. They had been treated with an extended (cases, group 1, n=15) or conservative (controls, group 2, n=15) 3- wall orbital decompression performed through a coronal approach. The deep portion of the lateral wall had been removed in the extended decompression group while preserved in the conservative decompression group. Demographics, preoperative characteristics, and surgical outcome were compared. The difference in mean exophthalmos reduction between groups 1 and 2was considered to be the contribution of the deep lateral wall to reduction of exophthalmos. RESUlTS: Groups 1 and 2 were drawn from a pool of 37 and 335 patients, respectively. Demographics and preoperative characteristics of the two groups were not significantly different. The mean contribution of the deep lateral wall to exophthalmos reduction was 2.3 mm. The onset of consecutive diplopia was not significantly different between the two groups (case n=2/15, controls n=5/15; P = .203). Diplopia resolved spontaneously in all the patients of group 1, while all the patients of group 2 required surgery. CONClUSIONS: Removal of the deep lateral orbital wall as part of a coronal-approach, 3- wall decompression, enhances the degree of exophthalmos reduction without increasing the risk of consecutive diplopia.

关键词：持续性复视深部外侧壁眼球突出

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外路泪囊鼻腔造瘘术中未缝合黏膜边界的长度

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世界核心医学期刊文摘（眼科学分册） 2005年第3期1卷 24-24页

作者： baldeschi l. macandie k. Hintschich C.R. 秦雪娇

To compare the extent of mucosal margins remaining unsutured at the end of ext ernal dacryocystorhinostomy (DCR) using single or double flap techniques and to evaluate the influence on outcome. Prospective, consecutive case series. The num ber and length of mucosal margins remaining unsutured at the end of external DCR were evaluated in 64 patients. Mucosal anastomosis was performed using either a conservative (group 1) or extended (group 2) double flap, or a single flap (gro up 3) dissection. Patients were selected for group 1 if the regional anatomy per mitted the desired dissection. All other patients were randomized to group 2 or 3. The mean length of unsutured mucosal margins was calculated for each group. S ubjects were followed up to 12 months, with final success rate recorded. In grou ps 1, 2, and 3 respectively: 11, 24 and 29 patients were recruited; four, 12, an d 10 mucosal margins remained unsutured; and the mean length of unsutured mucosa l margins was 16.36 mm (SD=2.8), 70.66 mm (SD=9.3), and 62.00 mm (SD=6.0). The m ean length of unsutured mucosal margins was significantly different, although gr oups 1 and 2 collectively did not have a significantly different mean length of unsutured mucosal margin from group 3. Mean follow up was 11 months (SD=2.2), 6 3 patients (98.43%) had a successful outcome with no significant difference amo ng groups (P=.429). Different patterns of mucosal dissection in external DCR cre ate a different number and extent of unsutured mucosal margins which do not appe ar to adversely affect the success rate of external DCR.

关键词：泪囊鼻腔造瘘术切除法局部解剖结构病例研究无显著性差异有显著性差异

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