儿童球内异物延迟取出的临床特征及手术术式选择的分析

doi:10.3877/cma.j.issn.2095-2007.2020.01.007

目的

探讨导致儿童球内异物延迟取出的致伤原因及异物特点，并分析其临床特征及手术术式的选择。

方法

收集2002年1月至2018年12月首都医科大学附属北京同仁医院北京同仁眼科中心因球内异物伤住院的91例(91只眼)儿童眼外伤的病例资料，并进行回顾分析。其中，男性81例(81只眼)，女性10例(10只眼)，年龄1~14岁，平均年龄(10.7±2.7)岁。根据致伤原因、异物性质、异物滞留位置、异物最长径、异物伤后并发症及异物延迟取出的手术方式进行分组。使用均数±标准差( ±s)描述年龄的分布情况；采用频数和百分比描述不同分组的病例数量和分布情况。使用卡方检验分析爆炸伤与非爆炸伤导致眼内炎发生率的差异。

结果

儿童球内异物伤首位致伤原因为爆炸伤，共55例(55只眼)，占60.4%；异物滞留位置中有74例(74只眼)异物滞留于玻璃体腔，占81.3%；异物性质中土质异物所占比例最大，共29例(29只眼)，占31.9%；44例(44只眼)为多个异物，占48.4%；异物最长径≥10 mm的巨大异物共12例(12只眼)，占13.2%。在伤后并发症中，视网膜裂孔者65例(65只眼)，占71.4%，居首位；其次为外伤性白内障者61例(61只眼)，占67.0%；再次为视网膜脱离者47例(47只眼，占51.6%)、增殖性玻璃体视网膜病变者27例(27只眼，占29.7%)及眼内炎者22例(22只眼，占24.2%)。异物延迟取出的手术术式选择中有83例(83只眼)行玻璃体切割术，占91.2%。其中，20例(20只眼)使用眼内窥镜辅助手术，占24.1%；63例(63只眼)使用联合晶状体摘除术，占69.2%。

结论

儿童球内异物患者以学龄男童高发，爆炸伤为致伤首要原因，泥沙、石块及烟花爆竹等土质异物占比最大。异物滞留于眼后段是异物延迟取出的主要原因。伤后可伴发外伤性白内障、视网膜裂孔、视网膜脱离、增殖性玻璃体视网膜病变及眼内炎等多种并发症。玻璃体切割联合晶状体摘除术是主要的手术方式。儿童球内异物伤并发症多，治疗棘手，故应积极预防儿童眼外伤的发生。

关键词: 眼外伤, 球内异物, 儿童, 延迟取出

Objective

The aim of this study was to investigate the causes of injuries and the characteristics of foreign body, analyze the clinical features and surgical procedures of delayed removal in pediatric intraocular foreign body (IOFB).

Methods

Medical records of pediatric ocular trauma patients with IOFB under hospitalization from January 2002 to December 2018 in Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University were collected and retrospectively analyzed. There were 91 patients (91 eyes) were enrolled in this study, including 81 males (81 eyes) and 10 females (10 eyes). The average ages were (10.7±2.7) years-old with a range from 1 to 14 years. The pediatric patients were divided into groups according to traumatic causes, natures of IOFBs, IOFB retained positions, the longest diameters of IOFBs, complications after trauma and surgical procedures. The distribution of age was described by mean±standard deviation (±s). Frequency and percentage were used to describe the quantities and distributions of cases. Chi-square test was used for comparison incidence rate of endophthalmitis between explosive injury group and non-explosive injury group.

Results

The most frequent cause of trauma was explosion, which had 55 cases (55 eyes) in total accounting for 60.4%. Among of the IOFB retained positions, there were 74 cases (74 eyes) accounting for 81.3% with IOFBs retained in vitreous cavity. Among of the natures of IOFBs, there were 29 cases (29 eyes) with earthy IOFBs, which accounting for 31.9% as the largest proportions. Multiple IOFBs can be found in 44 cases (44 eyes) accounting for 48.4%. 12 cases(12 eyes) with IOFBs were larger than or equal to 10 mm accounting for 13.2%. Of all the complications, 65 cases (65 eyes) accounting for 71.4% were retinal breaks to stand first; then 61 cases (61 eyes) were traumatic cataracts accounting for 67.0%, 47 cases (47 eyes) with retinal detachment which accounting for 51.6%, 27 cases (27 eyes) with proliferative vitreoretinopathy patients which accounting for 29.7%, and 22 cases (22 eyes) with endophthalmitis patients which accounting for 24.2%. Vitrectomy procedures were performed in 83 cases (83 eyes) accounting for 91.2%. Among of them, there were 20 cases (20 eyes) accounting for 24.1% with assistance of endoscopes; lensectomy procedures were performed in 63 cases (63 eyes) accounting for 69.2%.

Conclusions

Delayed removal of IOFBs in pediatric ocular trauma occurs more often in males than female, especially in school children. The principal cause of trauma was explosion. Slit, stones and fireworks accounted for the highest proportion of IOFBs. IOFB retained in posterior segment was the main reason for delayed removal. Many complications were along with trauma, such as traumatic cataract, retinal break, retinal detachment, proliferative vitreoretinopathy and endophthalmitis. Vitrectomy combined with lensectomy was the most common surgical procedure. Pediatric ocular trauma with IOFB had lots of complications and the treatments were complicated. Therefore, the active prevention of pediatric ocular trauma was important.

Key words: Ocular trauma, Intraocular foreign body, Pediatric, Delayed removal

图1 术中所见不同性质球内异物的彩色照相　图A示磁性金属异物，异物可被磁石吸引；图B示非磁性金属异物，异物为铝片，不可被磁石吸引；图C示土质异物，异物为黑色石块；图D示植物异物，红色圆圈内为木刺异物(此图为患者一期急诊手术时取出的木刺，二期手术再取出玻璃体腔内残留的异物)

表1 爆炸伤与非爆炸伤导致眼内炎患者眼数的比较[眼数(患眼数%)]

项目	总眼数	爆炸伤	非爆炸伤
眼内炎	22	14(63.64)	8(36.36)
非眼内炎	69	41(59.42)	28(40.58)
χ²值		0.124
P值		>0.05

表1 爆炸伤与非爆炸伤导致眼内炎患者眼数的比较[眼数(患眼数%)]

项目	总眼数	爆炸伤	非爆炸伤
眼内炎	22	14(63.64)	8(36.36)
非眼内炎	69	41(59.42)	28(40.58)
χ²值		0.124
P值		>0.05

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Analysis of clinical features and surgical procedures in pediatric patients with delayed removal of intraocular foreign body

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Analysis of clinical features and surgical procedures in pediatric patients with delayed removal of intraocular foreign body