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目的 探讨合并脉络膜脱离的孔源性视网膜脱离患者的手术疗效及其影响手术疗效的因素。方法 回顾 1996年 1月至 1998年 8月间 ,本院收治的 188例 (188只眼 )合并脉络膜脱离的孔源性视网膜脱离患者的临床资料 ,分析患者术前增生性玻璃体视网膜病变 (proliferativevitreoretinopathy,PVR)的分级、手术方式、术前糖皮质激素治疗等因素与手术疗效的关系。结果 本组患者手术治愈率为 83 0 % ,低于一般视网膜脱离的治愈率 ;PVR的A～B级手术治愈率为 89 6 % ,C1～C3 级为 84 1% ,D1～D3 级为 6 9 0 % ;PVR的C1～C3 级中 ,行玻璃体切除术者的手术治愈率高于行巩膜扣带术者 ;术前糖皮质激素使用者比未使用者手术治愈率高 ;糖皮质激素使用时间的长短与手术治愈率无关 ;巩膜扣带术者中 ,放液与不放液与手术治愈率无关。结论 合并脉络膜脱离的视网膜脱离患者 ,其视网膜脱离程度严重 ,PVR发展快 ,术前应及时给予糖皮质激素治疗 ,但不能延误手术时机。对PVR的A～B级、脉络膜脱离程度不严重的患者可行巩膜扣带术 ,尽量不放视网膜下液、不注气 ;对PVR的C级患者行玻璃体切除术是解决严重脉络膜脱离的有效方法 ,对脉络膜脱离程度较轻的患者也可行巩膜扣带术 ;PVR的D级患者应行玻璃体切除术
Objective To investigate the surgical treatment of rhegmatogenous retinal detachment with choroidal detachment and its influencing factors. Methods From January 1996 to August 1998, 188 patients (188 eyes) with rhegmatogenous retinal detachment undergoing choroidal detachment in our hospital were analyzed retrospectively. Preoperative proliferative vitreoretinopathy PVR) grading, surgical methods, preoperative glucocorticoid treatment and other factors and the effect of surgery. Results The cure rate of this group was 83 0%, which was lower than the cure rate of general retinal detachment. The cure rate of PVR grade A ~ B was 89 6%, C1 ~ C3 841%, D1 ~ D3 6 90% of PVR patients had higher operative cure rate than those who underwent scleral buckling surgery. The preoperative glucocorticoid users had a higher cure rate than non-users. The glucocorticoid use The length of time has nothing to do with the cure rate; scleral buckling surgery, the release and non-liquid and surgical cure rate has nothing to do. Conclusions Patients with retinal detachment complicated by choroidal detachment have severe degree of retinal detachment and rapid development of PVR. Glucocorticoid therapy should be given promptly before operation, but the timing of operation should not be delayed. PVR grade A ~ B, choroidal detachment is not serious in patients with scleral buckling surgery, as far as possible subretinal fluid, gas injection; PVR class C patients underwent vitrectomy is an effective method to solve severe choroidal detachment , The extent of choroidal detachment is also feasible for patients with scleral buckling; PVR grade D patients should be performed vitrectomy