超声乳化白内障摘除术与小切口白内障摘除术对角膜内皮细胞影响的对比研究

目的 通过观察超声乳化白内障摘除手术和小切口白内障摘除术对角膜内皮细胞的数量和形态学(变异系数、六角形细胞比例)以及中央角膜厚度的变化，分析两种手术方式对角膜内皮细胞的安全性。 方法 分析2015年1—12月就诊于蚌埠医学院第一附属医院的共200例白内障患者，分为2组，所有患者均接受6周的随访。超声乳化组患者100例，接受超声乳化白内障手术；小切口组患者100例，接受小切口白内障摘除术。对比2组患者术前、术后各时期中央角膜厚度、内皮细胞密度、变异系数及六角形细胞比例变化情况。 结果 术前、术后6周2组患者中央角膜厚度变化比较差异无统计学意义(P>0.05)，术后1周，小切口组患者中央角膜厚度变化与超声乳化组比较差异有统计学意义(P<0.05)。术前、术后各时期，2组患者内皮细胞密度变化比较差异无统计学意义(P>0.05)。2组患者各时期角膜内皮细胞面积变异系数及六角形细胞比例变化差异无统计学意义(P>0.05)。 结论 2种手术方式均会造成不同程度的角膜内皮细胞丢失，但两者对角膜内皮细胞功能和形态学的影响无显著差异。而术前详细的检查，术中精细、熟练的操作以及术后精心的观察治疗，是减少白内障患者角膜内皮细胞丢失的关键。 

A comparative study of the effect of phacoemulsification and small-incision cataract surgery corneal endothelial cells

Objective To observe and compare the influence of phacoemulsification and small-incision cataract surgery(SICS) on the endothelial cell count(ECC),the morphology(coefficient of variation and Hexagonality) of corneal endothelial cells(CECs) and the central corneal thickness(CCT),and evaluate the their safety on the CECs. Methods The clinical data of 200 cases of cataract in our hospital between January,2015 and December,2015 were analyzed.The patients were randomly divided into phacoemulsification group(100 cases) and SICS(100 cases),and all the patients were followed up for 6 weeks.The changes of CCT,endothelial cell density(ECD),coefficient of variation(CV) and Hexagonality were compared between the two groups after the operation. Results There was no significant difference in the observed indexes between the two groups before the operation and 6 weeks after the operation.The difference in CCT was statistically significant at 1 weeks after the operation between the two groups(P<0.05).There were no statistically significant differences in ECD loss between the two groups at 1 weeks and 6 weeks after the surgery(P>0.05).There were no statistically significant differences in CV and Hexagonality between the two groups before the operation,and 1 and 6 weeks after the surgery(P>0.05). Conclusion Both phacoemulsification and SICS can cause corneal endothelial cell loss to different degree,but there were no statistically significant differences between the two groups in the function and morphology of corneal endothelial cell.Preoperative examination,fine and skilled operation,careful observation after the operation are the keys to reduce the loss of CECs in cataract patients.