【作者】 王立斌；

【导师】 郑小波；

【作者基本信息】 西南大学 ， 临床兽医学， 2007， 硕士

【摘要】 通过对比犬晶状体超声乳化同步植入人工晶状体手术两种切口在术中、术后的情况，来探讨两种不同切口的差异性和护理要领，为本手术在临床上应用找到一种最合适的切口。本试验主要分为二个试验组。选用90—120日龄、体重在3—5Kg左右、体质健康均匀、眼无任何疾病及病史的杂种犬16只，公母各半。每个试验组用眼8只（左右各半），每只犬单独放一个铁犬笼子。动物分组按完全随机法进行，试验第1组犬眼行角膜透明切口超声乳化手术，植入人工晶状体；试验2组犬眼行巩膜隧道切口超声乳化手术，植入人工晶状体。所有超声乳化手术及同步植入人工晶状体由同一术者完成。试验测定术眼超声乳化时间，房水自由基和细胞因子的含量变化，及术眼的并发症前房积血、角膜混浊情况。透明角膜切口晶状体超声乳化平均时间为54s，巩膜隧道切口晶状体超声乳化平均时间为61.5s。经t检验，透明角膜切口晶状体超声乳化时间与巩膜隧道切口晶状体超声乳化时间差异性显著（P＜0.05）。晶状体超声乳化是该手术的关键步骤，可见透明角膜切口较巩膜隧道切口明显减少了手术时间。检测术眼房水肿瘤坏死因子—α（TNF—α）、过氧化氢（H₂O₂）和一氧化氮（NO）含量，试验结果表明：（1）透明角膜切口组在术后第3天房水中TNF-α含量达到最高值，组内差异不显著（P＞0.05）；在手术后3天，H₂O₂含量达到最高值，与手术前、手术后15天比较差异极显著（P＜0.01），与手术后7天比较差异性显著（P＜0.05）；在手术后3天，NO的含量达到最高值，与手术前、手术后15天比较差异极显著（P＜0.01），与手术后7天比较差异性显著（P＜0.05）。（2）巩膜隧道切口组在术后第7天房水中TNF—α含量达到最高值，组内差异不显著（P＞0.05）；在手术后3天，H₂O₂含量达到最高值，与手术前、手术后15天比较差异极显著（P＜0.01），与手术后7天比较差异性不显著（P＞0.05）；在手术后3天，NO的含量达到最高值，与手术前、手术后15天比较差异极显著（P＜0.01），与手术后7天比较差异性不显著（P＞0.05）。（3）在同一时期，透明角膜切口组与巩膜隧道切口组比较差异性不显著（P＞0.05），但透明角膜切口组NO和H₂O₂的平均数水平在手术3天、7天均高于同期巩膜隧道切口组。NO促使的炎症反应在手术后3天最为强烈，然后呈现下降趋势。尽管透明角膜切口存在着炎症反应比巩膜隧道切口强烈的趋势，但透明角膜切口组TNF-α在手术后3天达到最高，然后呈下降趋势，该组H₂O₂水平在手术后3天到手术后7天这段时间内下降明显，巩膜隧道切口组TNF-α在手术后7天达到最高，该组H₂O₂水平在手术后3天到手术后7天这段时间内下降不明显，可见巩膜隧道切口发生术后并发症的几率要高于透明角膜切口。检测术后巩膜隧道切口眼前房积血情况表明：经巩膜隧道切口手术后，前房有不同程度的积血；在手术后的最初6天，前房积血情况改变轻微，只有一只轻度积血的术眼得到改善；在手术后6天到15天这段时间，前房出血有了很大的改善，有6只术眼达到正常标准；手术后，有一只术眼前房积血严重，到术后15天时，仍未能得到改善。而透明角膜切口组没有出现前房积血现象。所以选择透明角膜切口可以有效避免前房积血的发生。检测手术后术眼角膜混浊情况表明：手术后3天角膜切口与巩膜隧道切口都出现了明显的角膜浑浊现象。此时，角膜切口的术眼出现重度混浊有1只，中度混浊的有3只，轻度混浊的有4只；巩膜隧道切口的术眼没有出现重度混浊，但中度混浊的有2只，轻度混浊的有6只。可见透明角膜切口在手术后角膜混浊现象比巩膜隧道切口严重。以后角膜浑浊现象逐渐得到改善。至手术后15天时，透明角膜切口恢复正常的眼有6只；巩膜隧道切口恢复正常的眼有7只。透明角膜切口和巩膜隧道切口角膜混浊现象都有了很大的改善，巩膜切口角膜混浊的恢复趋势更好一些。综合前面的试验结果表明：巩膜隧道切口、透明角膜切口在手术后一周内炎症反应剧烈，而在随后的一周内炎症逐渐消退达到正常水平；巩膜隧道切口的既有前房积血又出现角膜混浊，而透明角膜切口在出现角膜混浊的同时，没有出现前房积血；虽然角膜透明切口比巩膜隧道切口角膜混浊现象严重，但因为没有发生前房积血，乳化时间较短，手术并发症相对较少，故透明角膜切口较巩膜隧道切口相对优越。更多还原

【Abstract】 In order to discuss canine phacoemulsification and postoperative nursing’s difference between clear corneal incision and scleral tunnel incision, we design this test. Test animals are 16 healthy normal dogs, Their age is from 90 to 120 days old, and their weight is from 3 to 5 kilograms. They are divided randomly into two groups, one group receive phacoemulsification and intraocular lens implantation through clear corneal incision, the other group receive phacoemulsification and intraocular lens implantation through scleral tunnel incision. Those operations are accomplished by the same surgeon.. This test detects the content of tumor necrosis factor-α（TNF-α）, hydrogen peroxide（H₂O₂）, and nitrogen monoxide（NO） in testing eyes’ aqueous humor, and postoperative status of cloudiness of cornea and anterior chamber hyphema.By detecting the content of tumor necrosis factor-α（TNF-α）, hydrogen peroxide（H₂O₂）, and nitrogen monoxide（NO） in testing eyes’ aqueous humor, we discover that: （1） in clear corneal incision group, the content of TNF-αreaches its highest record on the 3rd day postoperatively, comparing with other days, the variability is not remarkable（P＞0.05）; the content of H₂O₂ reaches its highest record on the 3rd day postoperatively, comparing with the day preoperative and the 15th day postoperatively, the variability is extremely remarkable（P＜0.01）; comparing with the 6th day postoperatively, the variability is remarkable（P＜0.05）; the content of NO reaches its highest record on the 3rd day postoperatively, comparing with the day preoperative and the 15th day postoperatively, the variability is extremely remarkable（P＜0.01）; comparing with the 6th day postoperatively, the variability is remarkable（P＜0.05）; （2） in scleral tunnel incision group, the content of TNF-αreaches its highest record on the 6th day postoperatively, comparing with other days, the variability is not remarkable（P＞0.05）; the content of H₂O₂ reaches its highest record on the 3rd day postoperatively, comparing with the day preoperative and the 15th day postoperatively, the variability is extremely remarkable（P＜0.01）; comparing with the 6th day postoperatively, the variability is not remarkable （P＞0.05）; the content of NO reaches its highest record on the 3rd day postoperatively, comparing with the day preoperative and the 15th day postoperatively, the variability is extremely remarkable（P＜0.010）; comparing with the 6th day postoperatively, the variability is not remarkable（P＞0.05）; （3） the variability between the two groups is not remarkable（P＞0.05）.By. detecting postoperative status of anterior chamber hyphema in scleral tunnel incision group, we discover that: anterior chamber hyphema is unavoidable; the status of anterior chamber hyphema improves lightly in the first week postoperatively, only one eye changes to better. from the 6th day postoperatively to the 15th day, the status of anterior chamber hyphema improves greatly, there are 6 eyes getting well; the status of anterior chamber hyphema in a eye is serious, this eye does not change to better.By detecting postoperative status of cloudiness of cornea, we discover that: status of cloudiness of cornea on the 3rd day postoperatively is serious. Status of cloudiness of cornea changes to better in the next 12 days. On the 15th day postoperatively, there are 6 eyes getting well in clear corneal incision group. There are 7 eyes getting well in scleral tunnel incision group.From experimental result above we conclude that: inflammatory reaction is serious in both groups. and gets regression in the next week. Comparing scleral tunnel incision group with clear corneal incision, we found that the main complication in scleral tunnel incision is anterior chamber hyphema, and in clear corneal incision is cloudiness of cornea. Clear corneal incision is better than scleral tunnel incision.更多还原