论著

睑结膜乳头切除联合自体游离球结膜瓣移植术治疗春季角结膜炎

Clinical efficacy of surgical resection of conjunctival papillae combined with autologous conjunctival graft in treatment of vernal keratoconjunctivitis

:894-896
 
目的:探讨睑结膜乳头切除联合自体游离结膜瓣移植术治疗春季角结膜炎的临床效果。方法:在显微镜下对11例(22眼)春季角结膜炎患者行睑结膜乳头切除联合自体游离结膜瓣移植术,观察治疗效果。结果:术后随访36~48个月,11例(22眼)春季角结膜炎患者中,治愈19眼(86.36%),有效2眼(9.09%),无效1眼(4.55%),总有效率95.45%。结论:睑结膜乳头切除联合自体游离结膜瓣移植术是治疗春季角结膜炎安全、有效的方法。
Objective: To evaluate the efficacy and safety of surgical resection of conjunctival papillae combined with autologous conjunctival graft in the treatment of vernal keratoconjunctivitis (VKC). Methods: All 11 cases (22 eyes) with VKC were treated with surgical resection of conjunctival papillae in combination with autologous conjunctival graft. Clinical efficacy and safety were evaluated. Results: After 36 to 48 months of follow-up, 19 eyes were cured (86.36%), 2 eyes were improved (9.09%), and 1 eye was ineffective (4.55%). The total effective rate was 95.45%. Conclusion: Surgical resection of conjunctival papillae combined with autologous conjunctival graft is efficacious and safe in the treatment of VKC.
综述

原发性获得性鼻泪管阻塞发病机制的研究进展

Research progress on the pathogenesis of primary acquired nasolacrimal duct obstruction

:921-927
 
原发性获得性鼻泪管阻塞(primary acquired nasolacrimal duct obstruction,PANDO)是泪道阻塞性疾病中最常见的一类,好发于中老年女性,是眼科临床上的常见病、多发病,常继发急性或慢性泪囊炎的症状和体征,严重影响患者的日常工作和生活。本文对近年来PANDO可能的发病机制相关的研究进展、亟待解决的问题及未来研究的热点方向作一综述,旨在进一步加深对泪道阻塞性疾病发生发展的认识。
Primary acquired nasolacrimal duct obstruction (PANDO), which mainly occurs in the middle-aged and elderly women, is the most common type of obstructive diseases of the lacrimal duct, and it is also a common and frequently-occurring disease in ophthalmology. It constantly occurs secondary to various symptoms and signs of acute or chronic dacryocystitis, which seriously affects the daily work and life of patients. This article summarizes the research progress on the possible pathogenesis of PANDO in recent years, the urgent problems to be solved and the hot research directions in the future, aiming to further deepen the understanding of the occurrence and development of lacrimal obstructive diseases.
医学教育

基于眼科住院医师规范化培训学员视角的睑板腺囊肿诊疗培训效果调查

Training effectiveness survey of diagnosis and treatment for chalazion from ophthalmology trainees’ perspective in resident standardized training

:913-920
 
目的:探讨眼科住院医师规范化培训中睑板腺囊肿诊疗的培训效果及存在的问题,以期改进培训方式。方法:以2020年4月在中山大学中山眼科中心培训的154名学员为对象,进行问卷调查,采用SPSS 20.0统计学软件进行数据分析。结果:共76名专业型硕士(专硕)、78名住院医师培训(住培)学员完成了问卷调查。专硕具有睑板腺囊肿诊断、保守治疗及手术主刀经验的比例分别为40.8%、11.8%、7.9%;住培则显著高于前者,分别为79.5%(P<0.001)、60.3%(P<0.001)和21.8%(P=0.016)。对于关键诊疗环节的判断,90.8%的专硕选择了临床诊断(P=0.007),94.9%的住培则选择治疗方案(P<0.001)。去除囊壁、术中意外与破溃皮肤的处理是专硕难以掌握的手术步骤(P<0.001);而住培仅为去除囊壁(P<0.001)。结论:睑板腺囊肿诊疗水平在眼科住院医师规范化培训中亟待提高,并根据各类型学员的临床能力和认知差异,进行分级分类培训。
Objective: To explore the teaching effect of diagnosis and treatment on chalazion in the standardized training of ophthalmology residents and its existing problems, in order to improve the quality of the training systems. Methods: A self-designed questionnaire survey was conducted with 154 ophthalmology residents in Zhongshan Ophthalmic Center in April 2020, and the investigative data was analyzed using SPSS 20.0. Results: Totally 76 medical postgraduates and 78 ophthalmology residents completed the questionnaire survey. The proportions of medical postgraduates who had individual experience on diagnosis, conservative and surgical treatment of chalazion were 40.8%, 11.8%, and 7.9%. Compared to the former, ophthalmology residents had significantly higher proportion, with 79.5% (P<0.001), 60.3% (P<0.001), and 21.8% (P=0.016), respectively. For judging the important aspect of diagnosis and treatment process, the medical postgraduates chose the clinical diagnosis (90.8%) (P=0.007), while the ophthalmology residents paid more attention on treatment options (94.9%) (P<0.001). In the surgical procedures, removal of cyst wall, management of intraoperative accidents and skin ulcers are all their difficult skills to master for medical postgraduates (P<0.001), while only removal of cyst wall for residents (P<0.001). Conclusion: The training level of diagnosis and treatment of chalazion still needs to be improved in the standardized training of ophthalmology residents. The training should be carried out according to the clinical competence and cognition differences of various types of students.
医学教育

全眼模型在Wetlab眼科手术教学中的应用

Application of porcine orbit model in ophthalmic surgery teaching

:830-835
 
目前Wetlab眼科手术教学采用猪眼球作为教学模型,与实际手术差别较大,且无法满足外眼手术教学的需求。通过使用带有眼球、眼外肌、眶组织、眶骨及眼睑结构的全眼模型,可高度模拟真实手术场景,覆盖更多眼科手术教学需求。基于全眼模型构建多个眼科手术教学平台,依照培养阶段设计手术课程,创建新的评价体系,改变传统将“内眼”“外眼”分开的教学理念,可使年轻医师从一开始就建立眼科“分科而不分割”的整体思维,从而使眼科手术培训更加规范和完善。
Porcine eyes have been used as animal model in ophthalmic surgery training. However, it differs greatly from real surgery and cannot meet the needs of external eye surgery teaching. Porcine orbit model with eyeball, extraocular muscles, orbital tissue, bones and eyelids can be more realistic simulation of real surgeries and cover more needs for ophthalmic surgery teaching. By setting up ophthalmic surgery teaching platforms, designing staged course and creating new assessment methods based on porcine orbit model, the traditional concept about separation of internal and external eye is changed. This helps young doctors to establish a holistic view from the very beginning, that ophthalmic surgeries should not be split because of subspeciality. In this way, ophthalmic surgery training will become more standardized and perfected.
出版者信息