儿童基本型间歇性外斜视不同手术方式的疗效比较

目的　比较双眼外直肌后徙术与单眼一退一截术治疗儿童基本型间歇性外斜视的疗效。方法　研究对象为２０１１年８月至２０１４年１０月在南京医科大学附属南京儿童医院眼科被确诊为基本型间歇性外斜视并行手术治疗的患儿９３例１３７眼，行双眼外直肌后徙术（ｂｉｌａｔｅｒａｌｌａｔｅｒａｌｒｅｃｔｕｓｒｅｃｅｓｓｉｏｎ，ＢＬＲ-ｒｅｃ）４４例８８眼，行单眼一退一截术（ｕｎｉｌａｔｅｒａｌｒｅｃｅｓｓ-ｒｅｓｅｃｔｉｏｎ，Ｒ＆Ｒ）术４９例４９眼。采用三棱镜加交替遮盖法测量患儿经１ｈ诊断性遮盖前后注视６ｍ及３３ｃｍ调节性视标第一眼位的斜视度。检查患儿近立体视锐度。依据诊断性遮盖后测量的最大看远斜视度及双眼注视偏爱，行ＢＬＲ-ｒｅｃ或Ｒ＆Ｒ，所有手术均由同一医师完成。术后１ｄ、１个月、６个月检查患儿的斜视度和近立体视功能。结果　术后１～３ｄ及术后１个月，Ｒ＆Ｒ组的整体疗效均优于ＢＬＲ-ｒｅｃ组（χ２＝６．３２４，Ｐ＝０．０４２；χ２ ＝６．７４７，Ｐ＝０．０３４）。ＢＬＲ-ｒｅｃ组欠矫率在术后１～３ｄ及术后１个月均高于Ｒ＆Ｒ组（χ２＝５．９５９，Ｐ＝０．０１５；χ２＝６．４６１，Ｐ＝０．０１１），正位率及过矫率的差异无统计学意义（均为Ｐ＞０．０５）；术后远期两组疗效差异无统计学意义（均为Ｐ＞０．０５）。术后两组看远及看近斜视度的差异在各时间点均无统计学意义（均为Ｐ＞０．０５）。术后两组获得正常近立体视功能的患儿比例比较，差异无统计学意义（χ２＝０．０７５，Ｐ＝０．７８４）。结论　治疗儿童基本型间歇性外斜视应首选Ｒ＆Ｒ。

Different surgical methods for children with basic typeintermittent exotropia

Objective To compare the surgical outcomes of bilateral lateral rectus recession and unilateral recess-resection for children with basic intermittent exotropia. Methods Ninty-three children( 137 eyes) with basic intermittent exotropia who underwent surgery treatment was recruited from August 2011 to October 2014 in the Ophthalmology Department of Nanjing Children s Hospital Affiliated to Nanjing Medical University. Forth-four cases ( 88 eyes) underwent bilateral lateral rectus recessions ( BLR-rec group) , and 49 cases ( 49 eyes) underwent unilateral recess-resection ( R&R group) . The exodeviations were measured by the alternate prism cover test at both distance ( 6 m) and near ( 33 cm) with fixation on accommodative targets before and after I hour diagnostic occlusion test. The titmus stereo test was used to assess stereoacuity. The choice of surgery procedures were based on binocular fixation preference testing. The target angle for surgery was decided according to the largest distant deviation before or after diagnostic occlusion test. All of the surgeries were performed by the same ophthalmologist. The exanunation was carried out at postoperative I day ,1 month and 6 months. Results There were sigruficant differences in the surgical efficacy between two groups at postoperative I - 3 days and I month (X’ = 6. 324 ,P = 0. 042 ;Xz = 6. 747 ,P = 0. 034 ) , the R&R group were better than the BLR-rec group. The undercorrection rates in the BLR-rec group were sigruficantly higher than those in the R&R group at postoperative I -3 days and l month(X2 = 5. 959,P = 0. 015 ;X2 = 6. 461 ,P = 0. 011 ) , while there was no sigruficant differences in the success rate and overcorrection rate between the two groups ( all P > 0. 05 ). There was no sigruficant difference in the long-term surgical results between the two groups( all P > 0. 05 ) . There was no significant difference in the distant and near deviations at each follow-up visit between the two groups( all P > 0. 05 ) . There was no significant difference in the rates of normal near stereopsis between the two groups(X2 = 0. 075 ,P = 0. 784) . Conclusion R&R is the first choice in treatment of children with basic type intermittent exotropia.