[1]李春艳,朱安泰.糖尿病视网膜病变并发玻璃体积血手术时机选择[J].新乡医学院学报,2018,35(8):731-734.[doi:10.7683/xxyxyxb.2018.08.021]
　LI Chun-yan,ZHU An-tai.Choice of the operative opportunity for diabetic retinopathy complicated with vitreous hemorrhage[J].Journal of Xinxiang Medical University,2018,35(8):731-734.[doi:10.7683/xxyxyxb.2018.08.021]
点击复制

糖尿病视网膜病变并发玻璃体积血手术时机选择
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年8
页码:
731-734
栏目:
临床研究
出版日期:
2018-08-05

文章信息/Info

Title:
Choice of the operative opportunity for diabetic retinopathy complicated with vitreous hemorrhage
作者:
李春艳; 朱安泰
（咸阳市中心医院眼科，陕西　咸阳　712000）
Author(s):
LI Chun-yan; ZHU An-tai
（Department of Ophthalmology，Xianyang Center Hospital，Xianyang 712000，Shaanxi Province，China）
关键词:
糖尿病视网膜病变; 玻璃体积血; 玻璃体切割术; 手术时机
Keywords:
diabetic retinopathy; vitreous hemorrhage; vitrectomy; operative opportunity
分类号:
R587.1R774.1
DOI:
10.7683/xxyxyxb.2018.08.021
文献标志码:
A
摘要:
目的　探讨糖尿病视网膜病变（DR）并发玻璃体积血的最佳手术时机。方法　选择咸阳市中心医院2014年5月至2017年6月收治的DR并发玻璃体积血患者86例为研究对象，患者均行23G玻璃体切割术，根据手术时机将患者分为早期手术组（病程<1个月，n=29）、中期手术组（病程1～3个月，n=29）和晚期手术组（病程>3个月，n=28），记录3组患者术前和术后3个月时的视网膜厚度和视力，并评定临床疗效。结果　术前3组患者视网膜厚度及视力比较差异均无统计学意义（P>0.05）；3组患者术后3个月视网膜厚度小于术前，视力高于术前（P<0.05）；术后3个月，早期手术组患者视网膜厚度小于中期手术组和晚期手术组，视力高于中期手术组和晚期手术组（P<0.05）；术后3个月，中期手术组与晚期手术组患者视网膜厚度及视力比较差异无统计学意义（P>0.05）。早期手术组、中期手术组和晚期手术组患者治疗总有效率分别为89.66%（26/29）、65.52%（19/29）、64.29%（18/28），早期手术组患者治疗总有效率高于中期手术组和晚期手术组（χ2=4.858、6.026，P<0.05），但中期手术组与晚期手术组患者治疗总有效率比较差异无统计学意义（χ2=0.075，P>0.05）。早期手术组视神经萎缩、糖尿病黄斑水肿、玻璃体再次出血发生率分别为0.00%（0/29）、13.79%（4/29）和6.90%（2/29），中期手术组视神经萎缩、糖尿病黄斑水肿、玻璃体再次出血发生率分别为6.90%（2/29）、13.79%（4/29）和6.90%（2/29），晚期手术组视神经萎缩、糖尿病黄斑水肿、玻璃体再次出血发生率分别为3.57%（1/28）、17.86%（5/28）和14.29%（4/28），3组患者视神经萎缩、糖尿病黄斑水肿、玻璃体再次出血发生率比较差异均无统计学意义（χ2=2.049、0.243、0.543，P>0.05）。结论　DR并发玻璃体积血早期施行玻璃体切割术可有效减小患者视网膜厚度，提高视力，且不会增加并发症。
Abstract:
Objective　To investigate the optimal operative opportunity for diabetic retinopathy（DR） complicated with vitreous hemorrhage.Methods　A total of 86 cases of DR complicated with vitreous hemorrhage from May 2014 to June 2017 in Xianyang Center Hospital were selected as the research subjects，and all patients were treated with 23G vitrectomy.The patients were divided into early operation group （course of disease <1 months，n=29），medium-term operation group （course of disease was 1-3 months，n=29） and advanced operation group （course of disease >3 months，n=28） according to the operative opportunity.The retinal thickness and visual acuity of the patients in the three groups were recorded before and three months after operation，and the clinical effect was evaluated.Results　There was no significant difference in the retinal thickness and visual acuity among the three groups before operation （P>0.05）.The retinal thickness at three months after operation was less than that before operation，and the visual acuity at three months after operation was higher than that before operation in the three groups （P<0.05）.The retinal thickness in the early operation group was less than that in the medium-term operation group and the advanced operation group at three months after operation，and the visual acuity in the early operation group was higher than that in the medium-term operation group and the advanced operation group at three months after operation （P<0.05）.There was no significant difference in the retinal thickness and visual acuity between the medium-term operation group and the advanced operation group at three months after operation （P>0.05）.The total effective rate in the early operation group，medium-term operation group and the advanced operation group was 89.66% （26/29），65.52% （19/29） and 64.29% （18/28） respectively.The total effective rate in the early operation group was higher than that in the medium-term operation group and the advanced operation group （χ2=4.858，6.026；P<0.05），but there was no significant difference in the total effective rate between the medium-term operation group and the advanced operation group （χ2=0.075，P>0.05）.The incidences of optic atrophy，macular edema and vitreous rebleeding in the early operation group were 0% （0/29），13.79% （4/29） and 6.90% （2/29） respectively；and they were 6.90% （2/29），13.79% （4/29） and 6.90% （2/29） respectively in the medium-term operation group；and they were 3.57% （1/28），17.86% （5/28） and 14.29% （4/28） respectively in the advanced operation group.There was no significant difference in the incidences of optic atrophy，macular edema and vitreous rebleeding among the three groups （χ2=2.049，0.243，0.543；P>0.05）.Conclusion　Early vitrectomy for vitreous hemorrhage complicated with DR can effectively reduce retinal thickness，improve visual acuity；and it does not increase the risk of complications.

参考文献/References:

［1］　张凤俊，易敬林，李晶明，等.糖尿病视网膜病变发病机制研究进展［J］.眼科新进展，2016，36（6）：584-587.
［2］　LEE Y，KANG S，PARK Y H.Posterior subtenon triamcinolone acetonide in gas-filled eyes as an adjunctive treatment for complicated proliferative diabetic retinopathy［J］.Korean J Ophthalmol，2013，27（1）：28-33.
［3］　杨健，杨凤娟，苗晓，等.糖尿病性视网膜病变发生机制研究进展［J］.中国老年学杂志，2017，37（18）：4680-4682.
［4］　吴航，刘大川，杨惠清，等.23G与20G玻璃体切割治疗增殖性糖尿病视网膜病变玻璃体出血对比研究［J］.中国实用眼科杂志，2014，32（11）：1324-1327.
［5］　SALEHI A，BENI A N，RAZMJOO H，et al.Phacoemulcification with intravitreal bevacizumab injection in patients with cataractand coexisting diabetic retinopathy：prospective randomized study［J］.J Ocul Pharmacol Ther，2012，28（3）：212-218.
［6］　冯希敏，祁颖，张凤妍，等.玻璃体内注射雷珠单抗联合玻璃体切割术治疗增生型糖尿病视网膜病变的疗效观察［J］.眼科新进展，2016，36（11）：1079-1081.
［7］　VOROB′EVA I V，MERKUSHENKOVA D A，PARFENOVA E V，et al.The effect of fibrinolytic therapy for proliferative diabetic retinopathy complications on the angiogenic potential of the eye［J］.Vestn Oftalmol，2014，130（1）：31-36.
［8］　傅维娜，陈梅珠，王云鹏.手术前玻璃体腔注射雷珠单抗对增生型糖尿病视网膜病变患眼玻璃体切割手术操作时间及手术后视力的影响［J］.中华眼底病杂志，2016，32（1）：26-30.
［9］　NEMOTO E，MORISHITA S，AKASHI M，et al.A case of proliferative retinopathy complicated with tuberous sclerosis treated by vitreous surgery［J］.Case Rep Ophthalmol，2016，7（3）：277-283.
［10］　罗毅，梅海峰.微创玻璃体切割联合超声乳化术治疗增生性糖尿病视网膜病变的疗效观察［J］.眼科新进展，2014，34（6）：577-579.
［11］　李文利.增殖性糖尿病视网膜病变的手术时机探讨［J］.中国实用医刊，2011，38（22）：73-74.
［12］　刘建伟，李聪伶，于海群.雷珠单抗玻璃体内注射对增生型糖尿病视网膜病变玻璃体切割术效果的影响［J］.眼科新进展，2016，36（3）：265-267.
［13］　刘彩霞，谢青，生侠，等.激光光凝术治疗糖尿病视网膜病变时机的选择与治疗效果的相关性研究［J］.眼科新进展，2014，34（6）：575-576.
［14］　纪惠谦，李玲丽，梁敏，等.糖尿病视网膜病变玻璃体手术干预治疗时机探讨［J］.临床眼科杂志，2010，18（1）：20-22.
［15］　ZAMAN Y，REHMAN A U，MEMON A F.Intravitreal avastin as an adjunct in patients with proliferative diabetic retinopathy undergoing pars plana vitrectomy［J］.Pak J Med Sci，2013，29（2）：590-592.
［16］　王玉，盛艳娟，程朝晖，等.糖尿病视网膜病变玻璃体积血玻璃体切割手术时机探讨［J］.中华眼底病杂志，2007，23（4）：277-278.
［17］　尹妮，赵帅，朱红娜.康柏西普预处理联合玻璃体切割术治疗增生型糖尿病视网膜病变［J］.眼科新进展，2017，37（8）：770-772.
［18］　周卓琳，毕春潮，王睿.合并玻璃体积血的糖尿病视网膜病变患者的手术治疗分析［J］.国际眼科杂志，2013，13（8）：1648-1650.
［19］　高宁，邸瑢，谢安明，等.PDR合并玻璃体积血的玻璃体手术时机对术后远期疗效的影响［J］.国际眼科杂志，2017，17（9）：1738-1740.
［20］　薛鹏程，游志鹏，付书华，等.23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普治疗增生型糖尿病视网膜病变（PDR）的疗效分析［J］.眼科新进展，2017，37（5）：458-462.
［21］　KASIMOV  M，ALIEVA N I，MAMEDZADE A N.Results of YAG-laser vitreolysis in proliferative diabetic retinopathy complicated by vitreous hemorrhage［J］.Vestn Oftalmol，2014，130（4）：22-26.

相似文献/References:

[1]柴树洁,孙秀慧,刘向玲.家属参与性延续护理对糖尿病视网膜病变患者玻璃体切割术后治疗依从性及并发症的影响[J].新乡医学院学报,2021,38(1):080.[doi:10.7683/xxyxyxb.2021.01.018]
　CHAI Shujie,SUN Xiuhui,LIU Xiangling.Effect of family′s participatory continuing nursing on treatment compliance and complications of the patients with diabetic retinopathy after vitrectomy[J].Journal of Xinxiang Medical University,2021,38(8):080.[doi:10.7683/xxyxyxb.2021.01.018]
[2]庞　敏,魏　祎,翁孝刚.2型糖尿病视网膜病变危险因素分析[J].新乡医学院学报,2020,37(3):270.[doi:10.7683/xxyxyxb.2020.03.017]
　PANG Min,WEI Yi,WENG Xiaogang.Analysis of risk factors of type 2 diabetic retinopathy[J].Journal of Xinxiang Medical University,2020,37(8):270.[doi:10.7683/xxyxyxb.2020.03.017]
[3]赖江峰,彭　静,蓝诚红,等.雷珠单抗玻璃体腔注射联合玻璃体切割术治疗玻璃体积血疗效观察[J].新乡医学院学报,2020,37(7):691.[doi:10.7683/xxyxyxb.2020.07.022]
　LAI Jiangfeng,PENG Jing,LAN Chenghong,et al.Therapeutic effect of intravitreal injection of leizumab combined with vitrectomy in the treatment of vitreous hemorrhage[J].Journal of Xinxiang Medical University,2020,37(8):691.[doi:10.7683/xxyxyxb.2020.07.022]
[4]刘爱琴,宋子宣.改良视网膜光凝术治疗糖尿病视网膜病变的效果及其对血清血管内皮生长因子和内皮素-1水平的影响[J].新乡医学院学报,2019,36(4):372.[doi:10.7683/xxyxyxb.2019.04.018]
　LIU Ai-qin,SONG Zi-xuan.Effect of modified retinal photocoagulation on diabetic retinopathy and its effect on serum vascular endothelial growth factor and endothelin 1 levels[J].Journal of Xinxiang Medical University,2019,36(8):372.[doi:10.7683/xxyxyxb.2019.04.018]

更新日期/Last Update: 2018-08-05