山东地区白内障超声乳化术开展情况调查分析

目的通过对医师进行调查问卷方法了解山东地区白内障超声乳化术开展过程中面临的问题以及经验教训,为今后更好开展白内障超声乳化术提供临床理论指导。方法对山东地区县级以上医院(15所医院)31位主治以上职称医师进行白内障超声乳化术情况进行问卷调查,主要了解各级医师对超声乳化术知识的了解情况、掌握该手术的渠道、开展过程中遇到的主要问题和手术中主要技术难题以及手术的最常见和最难处理的并发症等,并征求他们的成功经验和教训。结果(1)超声乳化知识的了解情况:所有医师在行超声乳化术之前都对对超声乳化的原理、手术适应证以及并发症和术后处理都进行过比较详细的学习。主要学习途径包括培训班、学术会议、杂志、书籍和供应商等。(2)61.3%(19/31)的手术医生在开展超声乳化术之前都进行了500台以上的白内障囊外摘除术。(3)掌握该手术技术的渠道:观摩他人手术(28/31)、录像带(23/31)和学术会议(20/31)获得。但调查者认为学习超声乳化术最有效的方法是:专家或上级医生带教(21/31)、观看录像带(22/31)或他人手术(22/31)和初学者实验室(20/31)。(4)开展超声乳化术遇到的主要问题和手术中主要的技术难点:遇到的主要的问题是患者经济困难不愿接受(18/31)、无后节手术并发症处理条件(13/31)和手术技术难以掌握(12/31);手术中主要的技术难点是碎核和乳化(30/31)、连续环形撕囊(19/31)和超乳机操作(8/31)。(5)最常见的手术并发症:后囊破裂玻璃体脱出(27/31)、角膜水肿(23/31)和后囊破裂核脱入玻腔(9/31)、人工晶状体无法植入(9/31);被调查者认为最难处理的并发症是:角膜内皮细胞功能失代偿(19/31)、后囊破裂核脱入玻璃体腔(17/31)和化脓性眼内炎(15/31)。结论(1)在开展超声乳化技术之前除了注重理论知识的掌握之外,实际操作的培训是关键。(2)手术中后囊破裂和角膜水肿是最常见的并发症。(3)处理角膜病变的能力和完善的眼后段技术设备是开展超声乳化手术的必要保障。

The investigation of phacoemulsification in Shandong province

Objection To offer the clinical theoretical direction for the fact that more easy to develop the phacoemulsification through investigating the problem of the phacoemulsification in Shandong Province through carrying on questionnaire. Methods We carried on questionnaire investigation to 35 attending doctor and above of hospital of county level and above in Shandong about phacoemulsification, aim to find out the situation of doctor's knowledge of phacoemulsification, the way of grasping the technique, main technological difficulties problem and most common complications and so on, and also solicit their successful experience and lesson. Results We retrieve 31 effective questionnaires altogether. (1) Understanding situation of relative knowledge of phacoemulsification: All doctors have detailed understanding the principle, indication and complications of phacoemulsification and postoperative treatment before perform the operation. The way of learning phacoemulsification mainly include training classes, academic meetings, magazines, books, supplier and so on. (2) 61.3% of doctors (19/31) have done more than 500 ECCE before phacoemulsification. (3) The way of grasping phacoemulsification: View others' operation(28/31), watch video(23/31)and attend academic meetings(20/31), but investigated doctors think the most effective methods of phacoemulsification is: Teaching of expertors(21/31), watching video(22/31)or others' operation (22/31)and wet lab(20/31). (4) Mainly problem and technique difficulties of phacoemulsification: Lackness of money(18/31), lackness of the condition of posterior surgery(13/31), surgery technique difficult to grasp(12/31); Technique difficulties in phacoemulsification: Bisected nuclear and emulsification(30/31), continuous curvilinear capsulorhexis(19/31)and manipulate the machine(8/31).(5)The most common operation complication: posterior capsule rupture and vitreous emersion (27/31), cornea edema (23/31), the nuclear fall into the vitreous body(9/31), IOL can not implantatio(9/31); The most difficult complication: Bullous ketatopathy(19/31), the nuclear fall into the vitreous body(17/31)endophthalmitis(15/31). Conclusion (1)The practical training of operation is a key procedure before phacoemulsification. (2)Posterior capsule rupture and vitreous emersion is the most common complications of phacoemulsification. (3)Cornea surgery and posterior segment technique and instrument is the necessary guarantee of phacoemulsification.