《眼科显微手术学》求取 ⇩

1．1 概述(introduction)1

1 眼科显微手术学发展史(the developmental history of the ophthalmic microsurgery)1

1．2 角膜手术(corneal surgery)3

1．2．1 角膜移植术(keratoplasty)3

1．2．2 屈光性手术(refractive surgery)4

1．2．3 角膜上皮移植术(keratoepithelioplasty，KEP)6

1．2．4 角膜内皮移植术(endotheliaplasty)6

1．3 白内障摘除与人工晶状体植入术(cataract extraction and intraocular lens implantation)6

1．4 青光眼手术(glaucoma surgery)9

1．5 玻璃体手术(vitreous surgery)10

1．6 视网膜脱离手术(retinal detachment surgery)11

1．7 眼附属器手术(surgery of the ocular adnexa)11

1．9 展望(prospects)12

4．13．1 虹膜牵拉器(iris retractors)12

1．8 眼外伤手术(surgery of ocular trauma)12

2．1．2 手术室的结构(construction of the operating theater)17

2．1．3 手术室的设备(equipments of the operating theater)17

2 手术室(operating theater)17

2．1．1 手术室的位置(location of the operating theater)17

2．1 手术室的建立(establishment of the operating theater)17

2．1．4 洗手间(hand-washing room)19

2．1．5 器械室的设备(equipments of the instrumental room)19

2．2 手术室及器械的消毒(sterilizations of the operating theater and instruments)19

2．2．1 手术室空气的消毒(sterilizations of air in the operating theater)19

2．3 手术室的无菌技术(aseptic techniques in the operating theater)20

2．3．1 手术人员的术前准备(operator preoperative preparations)20

2．2．4 手术用品的覆盖(covering surgical articles)20

2．2．3 显微手术器械的消毒(sterilizations of the microsurgical instruments)20

2．2．2 手术显微镜的消毒(sterilizations of the operating microscope)20

2．3．2 手术野消毒(sterilization of operating area)21

2．4 手术室规则(regulations of the operating theater)21

2．4．1 进出手术室规则(regulations of pass in and out the operating theater)21

2．3．3 无菌操作法(aseptic manipulation)21

2．4．2 参观手术室规则(regulations of visit the operating theater)22

3 手术显微镜(operating microscope)23

3．1 概述(introduction)23

3．1．1 手术显微镜的基本结构(basic structures of the operating microscope)23

3．1．2 手术显微镜的主要性能(main performances of the operating microscope)23

3．1．3 手术显微镜的维护检查(maintenances of the operating microscope)24

3．2 Topcon眼科手术显微镜(Topcon operating microscope for ophthalmology)25

3．3 Zeiss眼科手术显微镜(Zeiss’s operating microscope for ophthalmology)27

3．4 手术放大镜(operating loupe)30

3．5．2 显微手术器械的摆放及其使用(location and directions of themicrosurgical instruments)31

3．5．3 切开法(incision)31

3．5．4 缝合法(suture)31

3．5．1 手术显微镜的调节(regulation of the operating microscope)31

3．5 基本操作与手术技巧(basic operation and surgical skill)31

3．5．7 拆线(stitches remove)32

3．5．6 剪线与埋线(cutting suture and embedding suture)32

3．5．5 打结(tieing，tying)32

4．1 概述(introduction)34

4．2 测量器(surveyors)34

4 手术器械(surgical instruments)34

4．2．1 测径规(calipers)35

4．2．2 直尺(rulers)36

4．2．3 测度计(degree gauges)36

4．2．4 Braunstein定位规(Braunstein’s fixed caliper)36

4．3 套管针/抛光器(cannula/polishers)37

4．3．1 空气注射针(air injection cannulas)37

4．3．2 前房冲洗针(flushing cannulas for the anterior chamber)37

4．3．5 钩状吸针(hooked cannulas)38

4．3．3 皮质吸除针(cortex extractor cannulas)38

4．3．4 晶状体吸盘(erisiphakes)38

4．3．6 灌注/抽吸针(irrigating/aspirating cannulas)39

4．3．7 玻璃体吸除针(vitreous aspirating cannulas)44

4．3．8 Trinkmann手柄式硅油吸除针(Trinkmann’s aspirating cannula handpiece for silicone oil)45

4．4．2 放射状角膜切开术标记器(corneal markers for radial keratotomy)46

4．4 角膜标记器(corneal markers)46

4．4．1 视区标记器(optical zone markers)46

4．5 巩膜压陷器(scleral depressors)49

4．6 手术镊(surgical forceps)51

4．6．1 双极电凝镊(bipolar forceps)51

4．6．2 异物镊(foreign body forceps)52

4．6．3 角膜/巩膜镊及巩膜穿刺口塞镊(cornear/scleral forceps and scleral plug forceps)53

4．6．4 虹膜镊(iris forceps)55

4．6．5 晶状体囊膜镊(capsule forceps)56

4．6．6 碎核镊(nuclear fragment forceps)58

4．6．7 人工晶状体镊(intraocular lens forceps)58

4．6．8 钻石型镊(jewellers type forceps)64

4．6．9 缝合镊(suturing forceps)65

4．6．10 打结镊(tying forceps)67

4．6．11 肌肉镊(muscle forceps)70

4．6．12 玻璃体视网膜镊(vitreoretinal forceps)71

4．6．13 组织镊(tissue forceps)73

4．6．14 固定镊(fixation forceps)74

4．6．15 撑开镊(spreading forceps)76

4．6．16 通用/敷料镊及弹簧镊(utility/dressing forceps and serrefines)77

4．7．1 固定钩/镐(nxation hooks/piek)80

4．7 手术钩(surgical hooks)80

4．7．2 虹膜钩(iris hooks)81

4．7．3 人工晶状体调位钩(intraocular lens hooks)82

4．7．4 晶状体核旋转器/碎核器(lens nucleus rotator/crackers)84

4．7．5 膜夹/膜钩/撬子/分离铲(membrane peelers/hooks/picks/spatulas)86

4．7．6 肌肉钩(muscle hooks)90

4．8．1 刀片与刀柄(blades and holders)92

4．8 手术刀(surgical knives)92

4．8．2 白内障刀(cataract knives)94

4．8．3 晶状体截囊针(cystotomes)95

4．8．4 超声乳化术切口刀(phaco blades)95

4．8．5 前房穿刺刀/针(knives/cannuas for paracentesis)96

4．8．6 角膜刀(corneal knives)96

4．8．7 作角膜屈光性手术的金刚石刀(corneal refractive diamond knives)97

4．8．10 巩膜穿刺刀(scleral pilot tube trocar)99

4．8．9 巩膜切离刀(scleral resection knife)99

4．8．8 异物剔除刀/针/铲(foreign body knives/needles/spuds)99

4．8．11 小梁切开器(trabeculotomes)101

4．8．12 前房角切开刀(goniotomy knives)101

4．9 手术圈套器/套环/匙/刮除器/勒除器/分离器(surgical loops/vectus/spoons/curette/snase/spatulas)102

4．9．1 晶状体圈套器/套环/匙(lens loop/vectus/spoons)102

4．9．2 眼球手术匙/勒除器(surgical spoons/snare of the eyeball)104

4．9．3 刮除器(curettes)105

4．9．4 分离器/骨凿(spatulas/chisel)106

4．10 手术剪(surgical scissors)108

4．10．1 角膜剪(corneal scissors)108

4．10．2 角膜剖切剪(corneal section scissors)110

4．10．3 Vannas剪(Vannas’s scissors)112

4．10．4 虹膜剪(iris scissors)113

4．10．5 线剪(suture/stitch scissors)114

4．10．6 断腱剪(tenotomy scissors)115

4．10．7 玻璃体剪(vitreous scissors)116

4．10．8 眼球摘除剪(enucleation scissors)117

4．10．9 斜视剪(strabismus scissors)118

4．10．10 通用剪(utility scissors)118

4．11 持针器(needle holders)119

4．11．1 显微手术持针器(microsurgical needle holders)120

4．11．2 普通手术持针器(common surgical needle holders)122

4．12．1 泪道探针(lachrymal probes)124

4．12 泪道探针/扩张器/金属线(lachrymal probes/dilators/wires)124

4．12．2 泪道扩张器(lachrymal dilators)126

4．12．3 泪小管金属线(canaliculus wires)126

4．13 牵拉器(撑开器、拉钩)/板(retractors/plate)127

4．13．2 泪囊撑开器(lachrymal sac retractors)128

4．13．3 眼睑拉钩/眼睑板(lid retractors/plate)129

4．13．4 眼眶拉钩/分离器(orbital retractors/elevator)130

4．14．1 开睑器(lid speculums)131

4．14 开睑器与固定环(lid speculums and fixation rings)131

4．15．1 角膜环钻(corneal trephine)133

4．15．2 咬切器(punches)133

4．14．2 固定环(fixation rings)134

4．15 环钻/咬切器(冲切器)/切割砧(trephine/punches/cutting blocks)135

4．15．3 角膜冲切器与切割砧(corneal punchs and cutting blocks)136

4．16 视网膜钉、玻璃体切除术透镜/透镜环(retinal tack，vitrectomy lenses/lensring)137

4．17 巩膜穿刺口塞/巩膜穿刺口导管固定器(scleral plugs/scleral pilot tubes packageds)138

4．18 烧灼器(cauteries)139

4．19 角膜锈环去除器(corneal rust ring removers)140

4．21 Caner球形体插入-支托器(Carter’s sphere introducer and holder)141

4．20 PRO-Lectro倒睫去除器(PRO-Leetro epilator)141

4．22 手术器械盘(surgical instrument trays)142

4．23 手术器械的保养与消毒器(maintenance and sterilizer of the surgical instruments)143

5 手术材料(surgical materials)145

5．1 缝针(needles)145

5．1．1 缝针的选择(choice of needles)145

5．1．2 缝针的类型(needle types)145

5．2 缝线(sutures)147

5．2．3 常用缝线(ordinary use sutures)148

5．2．1 缝线的性质(nature of sutures)148

5．2．2 缝线的规格(specification of sutures)148

5．3 粘弹剂(viscoelastics)150

5．3．1 生物化学特性(biochemical characteristics)150

5．3．2 品种特点(varietal features)150

5．3．3 作用与用途(actions and uses)153

5．4 眼内填充剂(intraocular filling materials)154

5．5 硅橡胶(silicone rubber)157

5．6 组织愈合剂(tissue healing materials)157

5．7 眼内灌注液(intraocular perfusate)158

5．8 人工晶状体(intraocular lens，IOL)159

5．9 青光眼房水引流植入器(aqueous drainage implants in glaucoma)163

6 手术仪器(surgical equipments)167

6．1 激光器(lasers)167

6．1．1 激光的生物效应(laser biologic effects)167

6．1．2 激光Q开关原理(laser Q-switched principle)169

6．1．3 氩离子激光器(argon：laser，Ar：laser)169

6．1．4 掺钕钇铝石榴石激光器(neodymium：Yttrium-Aluminum-Garnet laser，Nd：YAG laser)170

6．1．5 掺铒钇铝石榴石激光器(erbium：Yttrium-Aluminum-Garnetlaser，Er：YAG laser)172

6．1．7 准分子激光器(excimer laser)173

6．1．6 掺钕四氟化钇锂激光器(Nd：YLF laser)173

6．1．8 氪离子激光器(krypton：laser，Kr：laser)175

6．1．9 其他激光器(other lasers)175

6．2 晶状体超声乳化仪(uhraemulsifiers)176

6．2．1 Protege型超声乳化仪(Protege uhraemulsifier)176

6．2．2 Alcon超声乳化系列(Alcon’s uhraemulsifier series)178

6．3 玻璃体注吸切除器[vitreous infusion suction cutter，VISC；简称为玻璃体切除器(vitrecto-mv unit)]180

6．3．1 基本结构及其性能(basic structure and its stokes)180

6．3．2 Alcon玻璃体视网膜手术系统(Alcon’s vitreoretinal surgerysy stems)181

6．3．3 Premiere型显微手术系统(Premiere microvit)181

6．5 电凝器(electrocoagulators)182

6．4 GFX 8000型液/气交换机(GFX 8000 console fluid/gas exchange)182

6．6 冷凝器(cryocoagulators)183

6．7 A型超声扫描仪(A ultraemulsinic scanning)184

6．8 UItraScan?数码B型超声测量系统(UItraScan? B Imaging system)184

6．9 Eye MAPTM EH-290型三维角膜地形图仪(Eye MAPTM EH-290 corneal topographer)185

6．10 RenaissanceTM型便携式自动角膜曲率计(RenaissanceTM portable automated keratometer)185

7 眼科麻醉(ophthalmic anesthesia)187

7．1 术前访视(preoperative visit)187

7．2 术前准备(preoperativepre parations)188

7．3 麻醉前给药(preanesthetic medication)188

7．4 麻醉选择(choice of anesthesia)189

7．5 局部麻醉(local anesthesia)190

7．5．1 局部麻醉药(local anesthetics)190

7．5．2 表面麻醉(topical anesthesia，surface anesthesia)193

7．5．3 浸润麻醉(infiltrative anesthesia)193

7．5．4 神经阻滞麻醉(nerve blocks)194

7．6 全身麻醉(general anesthesia)199

7．6．1 常用吸入全麻药(commonly used anesthetics for inhalation anesthesia)200

7．6．2 静脉和复合麻醉常用药(commonly used drugs for intravenous and combined anesthesia)201

7．6．3 肌肉松弛药(muscle relaxants)202

7．6．4 全麻设备(equipment of general anesthesia)204

7．6．5 全麻实施方法(performance of general anesthesia)205

7．7 麻醉并发症(anesthetic complications)207

7．7．1 局麻并发症(complications of local anesthesia)207

7．7．2 全麻并发症(complications of general anesthesia)209

7．7．3 眼心反射(oculocardiac reflex)209

7．8 心肺脑复苏(cardiopulmonary-cerebral resuscitation)210

8．1．1 眼库的任务(duties of the eye bank)213

8．1．2 眼库的设备(apparatus of the eye bank)213

8．1 眼库与供体角膜的保存(eye bank and preservation of donor corneas)213

8 角膜手术(corneal surgery)213

8．1．3 供体角膜的选择(selection of donor corneas)214

8．1．4 眼库的保存技术(storage techniques of the eye bank)216

8．1．5 角膜内皮细胞活性的评价(estimation of the corneal endothelial cell viability220

8．2 穿透性角膜移植术(penetrating keratoplasty，PK)222

8．2．1 成人穿透性角膜移植术(adult penetrating keratoplasty，APK)222

8．2．2 桥式穿透性角膜移植术(bridge type of penetrating keratoplasty)231

8．2．3 白内障囊外摘除、人工晶状体植入联合穿透性角膜移植术[extracapsular calaract extra-ction(ECCE)，intraocular lens(IOL)implatation combined with PK]232

8．2．4 儿童穿透性角膜移植术(penetrating keratoplasty in children)233

8．3 眼球前段重建术(reconstruction of the aterlor segment)234

8．4 角膜化学伤手术(surgery of corneal chemical burns)234

8．5 板层角膜移植术(lamellar keratoplasty，LK)237

8．6 准分子激光角膜移植术(excimer laser keratoplasty)241

8．7 表层角膜镜片术(epikeratophakia，EP)242

8．8 人工角膜成形术(prosthokeratoplasty)244

9 结膜手术(surgery of the coxjunctiva)249

9．1 结膜的应用解剖、生理和组织病理(applied anatomy，physiology and histopathology of the conjunctiva)249

9．1．1 结膜的解剖特点(anatomical peculiarity of the conjunctlva)249

9．1．2 临床组织学联系(correlation between clinical medicine and histology)249

9．1．3 结膜上皮与角膜上皮在组织和生化上的差异(differences between the conjunctival epi-thelia and corneal epithelia in histology and biochemistry)250

9．1．4 影响结膜横向分化的局部因素(local influential factors in conjunctival transdifferentiat-ion)250

9．2．2 结角膜化学伤修复术(repair of chemical burns of the conjunctlva and cornea)251

9．2 结膜外伤手术(surgery of conjunctival injuries)251

9．2．1 球结膜撕裂伤修补术(repair of bulbar conjunctival laceration)251

9．3 球结膜环切术(bulbar conjunctival peritomy)253

9．4 翼状胬肉手术(surgery of pterygmm)253

9．5 眼球表面肿瘤切除术(removal of epibulbar tumors)257

9．6 球结膜瓣手术(surgery of the bulbar conjanctival flap)259

9．6．1 部分球结膜瓣掩盖术(covering of the partial bulbar conjunctival flaps)259

9．6．2 全球结膜瓣掩盖术(Gundersen’s total conjnctival flap)261

9．6．3 球结膜瓣联合板层角巩膜移植术(conjunctival flap combined with lamellar keratoscler-al grafting)261

9．7．1 部分睑球粘连修复术(repair of partial symblepharon)262

9．7 睑球粘连修复术(repair of symblepharon)262

9．7．2 全睑球粘连修复术(repair of total symblepharon)263

9．8 球结膜移植术(transplantation of the bulbar conjunctiva)264

10 屈光性手术(refractive surgery)266

10．1 近视眼手术(myopic surgery)266

10．1．1 概述(introduction)266

10．1．2 放射状角膜切开术(radial keratotomy，RK)266

10．1．3 后巩膜加固术(posterior scleral support operation，PSSO；posterior scleral reinforce-ment operation，PSRO)282

10．1．4 准分子激光屈光性角膜切削术(photorefractive keratectomy，PRK)284

10．1．5 激光原位角膜磨镶术治疗近视[laser in situ keratomileusis(LASIK)for treatment of myopia]290

10．2．1 激光角膜热成形术治疗远视(laser thermokeratoplasty for treatment of hyperopia)296

10．2 远视眼手术(hyperopic surgery)296

10．2．2 激光原位角膜磨镶术治疗远视(laser in situ keratomileusis for treatment of hyperopia)298

11 青光眼手术(glaucoma surgery)303

11．1 概述(introduction)303

11．2 周边虹膜切除术(peripheral iridectomy)304

11．3 滤过性手术(fihering surgery)306

11．3．1 小梁切除术(trabeculectomy)306

11．3．2 巩膜咬切术(anterior or posterior lip sclerectomy)312

11．3．3 灼瘘术(thermal sclerotomy，Scheie’s operation)313

11．3．4 虹膜嵌顿术(iridencleisis)314

11．3．6 有关周边虹膜切除术和滤过性手术的几点评论(some comments on peripheral iridec-tomy and filtering surgery)316

11．3．5 环钻术(limbal trephination)316

11．4 小梁切除联合白内障囊外摘除术(trabeculectomy combined with extracapsular cataract extraction)319

11．5 睫状体分离术(cyclodialysis)322

11．6 先天性青光眼手术(congenital glaucoma surgery)324

11．6．1 前房角切开术(goniotomy)324

11．6．2 小梁切开术(trabeculotomy)326

11．6．3 小梁切除术(trabeculectomy)329

11．6．4 用于治疗先天性青光眼的其他类型青光眼手术(other type of glaucoma surgeries used for congenital glaucoma)329

11．7．2 睫状体冷凝术(cyclocryotherapy)330

11．7 睫状体破坏性手术(cyclodestructive procedures)330

11．7．1 睫状体透热术(cyclodiathermy)330

11．8 泄液线手术(seton procedures)332

11．8．1 Molteno引流器植入术(Molteno’s shunt implant)332

11．8．2 Krupin-Denver阀门器植入术(Krupin-Denver’s valve implant)333

11．8．3 AhmedTM青光眼阀门器植入术(AhmedTM’s glaucoma valve implant)335

11．9 青光眼的激光手术(laser surgeries in glaucoma)336

11．9．1 激光虹膜切开术(laser iridotomy)336

11．9．2 激光前房角成形术(laser gonioplasty)339

11．9．3 激光小梁成形术(laser trabeculoplasty，LT)340

11．9．4 激光睫状体破坏性手术(laser cyclodestructive surgeries)342

11．9．5 激光滤过性手术(laser filtering surgeries)344

12 前房与虹膜病手术(surgeries of the anterior chamber and iridopathy)347

12．1 前房手术(surgery of the anterior chamber)347

12．1．1 前房穿刺术(paracentesis)347

12．1．2 空气注入前房术(air injection for the anterior chamber)349

12．2 虹膜病手术(surgery of iridopathy)350

12．2．1 虹膜新生物切除术(resection of iridic neoplasm)350

12．2．2 瞳孔闭锁或瞳孔膜切除术(resection of seclusio pupillae or membrana pupillaris)351

12．2．3 虹膜脱出整复法(iridoptosis taxis)353

12．2．4 虹膜切开术(iridotomy)354

12．2．5 瞳孔括约肌切开术(pupillary sphincterotomy)355

12．2．6 虹膜膨隆贯穿术(transfixion for iris bombe)355

12．2．7 虹膜根部离断修复术(prothesis of iridodialysis)356

12．2．8 虹膜粘连分离术(synechotomy)358

12．2．9 激光瞳孔成形术(laser coreoplasty)359

13 白内障摘除与人工晶状体植入术(cataract extraction and intraocular lens implantation)362

13．1 角膜缘、晶状体及其悬韧带的应用解剖(applied anatomy of the limbus，lens and its sus -pensory ligament)362

13．2 白内障摘除术(cataract extraction)364

13．2．1 白内障囊外摘除术(extracapsular cataract extraction，ECCE)364

13．2．2 软性白内障吸出术(soft cataract aspiration)379

13．2．3 白内障摘除联合其他手术(cataract extraction combined with other surgeries)380

13．2．4 特殊白内障手术(specific cataract surgeries)383

13．2．5 白内障囊内摘除术(intracapasular cataract extraction，ICCE)385

13．2．6 白内障超声乳化吸出术(phacoemulsification，PEM)387

13．2．7 白内障激光乳化吸出术(laser phacoemulsification)390

13．3 人工晶状体植入术(intraocular lens implantation，IOLl)393

13．3．1 后房型人工晶状体植入术(posterior chamber intraocular lens implantation)394

13．3．2 前房型人工晶状体植入术(anterior chamber intraocular lens implantation)406

13．3．3 人工晶状体植入联合其他手术(IOL implantation combined with other surgeries)409

13．3．4 特殊条件下人工晶状体植入术(IOL implantation in specific conditions)414

14 玻璃体手术(vitreous surgery)424

14．1 概述(introduction)424

14．2 设备与器械(equipments and instruments)424

14．2．1 玻璃体注吸及切除系统(vitreous infusion，suction and cutter systems)424

14．2．2 观察系统(viewing system)425

14．2．3 照明系统(illumination system)425

14．2．4 机器辅件及器械(machine accessories and instruments)425

14．2．5 清洁与灭菌(cleaning and sterilization)425

14．3 平坦部玻璃体切除术(pars plana vitrectomy，PPV)425

14．4．2 异位玻璃体切除术(removal of displacement vitreous)428

14．4．1 瞳孔膜切除术(removal of pupillary membranes)428

14．4 特殊玻璃体切除术(specific vltrectomy)428

14．4．3 人工晶状体取出术(removal of intraocular lens)429

14．4．4 后路晶状体切除术(lensectomy via pars ptana)429

14．4．5 玻璃体积血切除术(removal of vitreous hemorrhages)430

14．4．6 玻璃体视网膜粘连切除术(removal of vitreous adherent to disk or retina)430

14．4．7 玻璃体机化条索切除术(removal of vitreous strands and bands)431

14．4．8 视网膜前膜切除术(removal of preretinal membrane)431

14．4．9 玻璃体腔灌洗术(lavage of vitreous cavity)431

14．4．10 眼内异物取出术(removal of intraocular foreign bodies)432

14．4．11 视网膜切开术(retinotomy)432

14．4．13 眼内填充术(intraocular tampon)433

14．4．12 眼内凝固术(intraocular coagulation)433

14．4．14 硅油取出术(removal of silicone oil)435

14．5 玻璃体切除术治疗复杂性视网膜脱离(vitrectomy for complicated retinal detachment)436

14．5．1 巨大裂孔视网膜脱离(retinal detachment caused by grant tear)436

14．5．2 合并屈光间质混浊的视网膜脱离(retinal detachment associated with opaque ocular media)437

14．5．3 后极部裂孔视网膜脱离(retinal detachment caused by posterior retinal break)438

14．5．4 合并严重PVR的视网膜脱离(retinal detachment with severe proliferative vitreoretino-pathy)438

14．5．5 牵引性视网膜脱离(tractional retinal detachment)439

14．5．6 外伤性视网膜脱离手术联合眼内异物取出术(traumatic retinal detachment surgery combined with removal of intraocular foreign bodies)439

14．5．8 黄斑下积血取出术(removal of submaeular hemorrhage)440

14．5．7 黄斑下新生血管膜取出术(removal of submacular neovascular membranes)440

14．5．9 特发性黄斑裂孔的手术治疗(surgical management for special macular hole)441

14．6 开放式玻璃体切除术(open-sky vltreetomy)441

14．7 玻璃体手术并发症(complications of vitreous surgery)443

14．7．1 术中并发症(intraoperatlve complications)443

14．7．2 术后并发症(postoperative complications)444

15 视网膜脱离手术(retinal detachment surgery)449

15．1 孔源性视网膜脱离复位术(reposition for rhegmatogenous retinal detachment)449

15．1．1 术前检查(preoperative examinations)449

15．1．2 手术方法(surgical methods)452

15．1．3 术式选择原则(guild line for selection of procedures)456

15．1．4 手术操作(surgical technique)458

15．1．5 视网膜裂孔的预防性治疗(prophylac tictreatment of retinal breaks)460

15．2 特殊视网膜脱离的处理(treatment of specific retinal detachment)460

15．2．1 视网膜锯齿状缘截离(dialysis of the ora serrata retinae，retinodialysis)460

15．2．2 黄斑裂孔视网膜脱离(macular hole with retinal detachment)460

15．2．3 无晶状体或人工晶状体眼视网膜脱离(aphakic retinal detachment or pseudophakic retinal detachment)462

15．2．4 视网膜脱离伴脉络膜脱离(retinal detachment associated with choroidal detachment)463

15．2．5 急性视网膜坏死伴视网膜脱离(acute retinal necrosis with retinal detachment)463

15．2．7 脉络膜缺损合并视网膜脱离(choroidal coloboma with retinal detachment)464

15．2．6 放射状角膜切开术后视网膜脱离(retinal detachment after radial keratotomy)464

15．2．8 牵牛花综合征合并视网膜脱离与视盘小凹合并视网膜脱离(morning glory syndrome with retinal detachment and optic disc pit with retinal detachment)465

15．2．9 先天性青光眼合并视网膜脱离(congenital glaucoma with retinal detachment)465

15．2．10 Marfan综合征合并视网膜脱离(Marfan’s syndrome with retinal detachment)465

15．2．11 视网膜静脉周围炎与视网膜分支静脉阻塞伴孔源性视网膜脱离(Eale’s disease and branch retinal vein occlusion with retinal detachment)466

15．3 玻璃体切除术治疗复杂性视网膜脱离(vitrectomy for complicated retinal detachment)466

15．3．1 先天性白内障摘除术后无晶状体眼合并视网膜脱离(aphakic retinal detachment folio-wing congenital cataract extraction)466

15．3．2 玻璃体后脱离、玻璃体积血合并视网膜脱离(posterior vitreous detachment，vitreous hemorrhage with retinal detachment)467

15．3．3 老年性白内障合并视网膜脱离(senile cataract with retinal detachment)468

15．3．5 巨大裂孔视网膜脱离(retinal detachment caused by giant tear)469

15．3．4 后极部裂孔视网膜脱离(retinal detachment caused by posterior retinal break)469

15．3．6 增生性玻璃体视网膜病变(proliferative vitreoretinopathy，PVR)470

15．3．7 牵引性视网膜脱离(tractional retinal detachment)472

15．3．8 眼球穿孔伤后牵引性视网膜脱离(tractional retinal detachment followint ocular penetrat-ing injury)473

15．3．9 早产儿视网膜病变的治疗(treatment of premature retinopathy)474

15．4 视网膜脱离手术并发症(complications of retinal detachment surgery)474

15．4．1 术中并发症(intraoperative complications)474

15．4．2 术后并发症(postoperative complications)477

16 眼外肌手术(surgery of the extraocular muscles)483

16．1 眼外肌的应用解剖及其生理(applied anatomy and physiology of the extraocular muscles)483

16．2 眼外肌的手术特点(surgical characteristics of the extraocular muscles)489

16．3 水平及垂直直肌手术(surgery of the horizontal and vertical rectus muscles)493

16．3．1 直肌后徙术(recession of the rectus muscles)493

16．3．2 直肌截除术(resection of the rectus muscles)497

16．3．3 直肌延长术(rectus muscle lenthening procedure)498

16．4 斜肌手术(surgery of the oblique muscles)500

16．4．1 下斜肌后徙术(recession of the inferior oblique muscle)500

16．4．2 卜斜肌切除术(myectomy of the inferior oblique muscle)502

16．4．3 下斜肌折叠术(tucking of the inferior oblique muscle)503

16．4．4 上斜肌(腱鞘内)断腱术[tenotomy(intra-sheath)of the superior oblique muscle]504

16．4．5 上斜肌肌腱伸展术(expanding procedure of the superior oblique tendon)505

16．4．6 上斜肌折叠术(tucking of the superior oblique muscle)506

16．4．7 上斜肌前徙术(advancement of the superior oblique muscle)507

16．5 眼外肌麻痹的手术(surgery of extraocular muscle paralysis)509

16．5．1 外直肌麻痹的手术(surgery of lateral rectus muscle paralysis)509

16．5．2 动眼神经麻痹的手术(surgery of the oculomotor nerve paralysis)511

16．6 眼外肌移位术(transposition of the extraocular muscles)512

16．6．1 水平直肌垂直移位术(vertical transposition of the horizontal rectus muscles)512

16．6．2 垂直直肌水平移位术(horizontal transposition of the vertical rectus muscles)513

16．6．3 双眼垂直直肌水平移位术(binocular horizontal transposition of the vertical rectus mu-scles)514

16．6．5 悬吊后徙术(Hang-back recession)515

16．6．4 直肌斜向后徙术(slanted recession of the rectus muscles)515

16．7 Duane眼球后退综合征手术(surgery of Duane’s retraction syndrome)516

16．8 A-V型斜视矫正术(correction of A and V pattern deviation)517

16．9 分离性垂直偏斜手术(surgery of the dissociated vertical deviation)519

16．10 直肌后固定缝线术(posterior fixation suture of the rectus muscles)519

16．11 眼球震颤的手术(surgery of nystagmus)520

16．12 手术并发症(operative complications)521

17．1．1 诊断方法(diagnostic methods)525

17．1．2 眼内细针穿吸活检术(intraocular fine-needle aspiration biopsy)525

17．1 眼内肿瘤的处理(management of intraocular tumors)525

17 眼内肿瘤的处理及眼球手术(management of intraocular tumors and surgery of the eyeball)525

17．1．3 治疗原则(principles of treatment)526

17．1．4 观察(observation)527

17．1．5 光凝(photocoagulation)527

17．1．6 放射治疗(radiotherapy)530

17．1．7 冷冻治疗(cryotherapy)534

17．1．8 透热治疗(diathermy)535

17．1．9 化学治疗和免疫治疗(chemotherapy and immunotherapy)535

17．2 虹膜切除术(iridectomy)536

17．3 虹膜睫状体切除术(iridocyclectomy)537

17．4 穿透性巩膜脉络膜视网膜玻璃体切除术(penetrating sclerochorioretinovitrectomy)538

17．5 部分板层巩膜脉络膜切除术(partial lamellar sclerochoroidectomy)539

17．6 眼球摘除术(enucleation)541

17．7 眶内植入物及义眼(intraorbital implant and artificial eye)544

17．8 眼内容剜出术(evisceration)546

18 眼睑病手术(surgery of eyelid diseases)549

18．1 眼睑的应用解剖(applied anatomy of the eyelids)549

18．1．1 眼睑皱襞(palpebral folds)549

18．1．2 睑裂(palpebral fissure)549

18．1．5 眼睑组织(eyelid tissues)550

18．1．4 睫毛(cilia)550

18．1．3 睑缘(palpebral margin)550

18．1．6 眼睑的血管和淋巴管(blood vessels and lymphatics of the eyelids)553

18．1．7 眼睑的神经分布(innervation of the eyelids)553

18．2 术前准备(preoperative preparation)555

18．2．1 全身情况(general circumstances)555

18．2．2 眼部情况(ocular circumstances)555

18．2．3 选择手术时机(choice of operative time)555

18．2．4 制定手术方案(making an operative plan)555

18．3．1 麦粒肿切开术(incision of hordeolum)556

18．3 眼睑小手术(small procedures of the eyelids)556

18．2．7 术后处理(postoperative management)556

18．2．6 供皮区的选择(selection of donor-skin area)556

18．2．5 麻醉选择(selection of anesthesia)556

18．3．2 眼睑脓肿切开术(incision of palpebral abscess)557

18．3．3 霰粒肿摘除术(extraction of chalazion)558

18．4 眦部手术(surgery of the canthus)559

18．4．1 外眦切开术(lateral canthotomy)559

18．4．2 睑裂扩大术(blepharodiastasis)559

18．4．3 睑裂缩短术(blepharoshortening procedures)560

18．5．1 睑缘缝合术(blepharorrhaphy)562

18．5 睑缘手术(surgery of the lid margin)562

18．5．2 倒睫矫正术(correction of trichiasis)563

18．6 睑内翻矫正术(correction of entropion)566

18．6．1 先天性睑内翻矫正术(correction of congenital entropion)566

18．6．2 老年痉挛性睑内翻矫正术(correction of senile spastic entropion)567

18．6．3 老年松弛性睑内翻矫正术(correction of senile atonic entropion)569

18．6．4 下睑内翻结膜径路矫正术(correction of lower entropion by transcon-junctival pathway)570

18．6．5 瘢痕性睑内翻矫正术(correction of cicatricial entropion)571

18．7 睑外翻矫正术(correction of ectropion)576

18．7．1 瘢痕性睑外翻矫正术(correction of cicatricial ectropion)576

18．7．2 老年性睑外翻矫正术(correction of senile ectropion)581

18．7．3 麻痹性睑外翻矫正术(correction of paralytic ectropion)583

18．7．4 先天性睑外翻矫正术(correction of congenital ectropion)584

18．8 眼睑肿瘤手术(surgery of eyelid tumors)584

18．8．1 眼睑肿瘤的诊断(diagnosis of eyelid tumors)584

18．8．2 眼险恶性肿瘤(malignantey elid tumors)585

18．8．3 眼睑良性肿瘤(benign eyelid tumors)592

19 泪器手术(surgery of the lacrimal system)597

19．1 泪腺的应用解剖(applied anatomy of the lacrimal glands)597

19．1．1 基础泪腺(basic lacrimal glands)597

19．1．2 反射泪腺(reflex lacrimal glands)598

19．1．3 泪膜(tear film)599

19．1．4 泪功能(function of the tears)601

19．2 泪道的应用解剖(applied anatomy of the lacrimal passages)601

19．2．1 泪道(lacrimal passages)602

19．2．2 泪道附件(appendages of the lacrimal passages)603

19．2．3 排泪机理(mechanism of the tear drainage)603

19．3 泪器的功能检查(functional examination of the lacrimal system)603

19．3．1 排泪功能检查(functional examination for evaluating lacrimal drainage)603

19．3．2 泌泪功能检查(functional examination for evaluating tear secretion)606

19．4．1 唇粘膜移植术(labiomucosa transplant)612

19．4 泪腺手术(surgery of the lacrimal glands)612

19．3．3 涎腺功能检查(functional examination of the salivary glands)612

19．4．2 睑板或睑板腺移植术(transplantation of the tarsus or meibomian glands)613

19．4．3 蝶腭节酒精阻断术(blocking sphenopalatine ganglion with alcohol)614

19．4．4 睑部泪腺酒精注射术(alcohol injecting into the palpebral lacrimal glands)615

19．4．5 泪腺切开术(incision of the lacrimal glands)615

19．4．6 睑部泪腺部分切除术(partial excision of the palpebral lacrimal glands)615

19．4．7 睑部泪腺电解术或电凝术(electrolysis or electrocoagulation of the palpebral lacrimal glands)616

19．4．8 脱垂泪腺复位术(reposition of prolapsus lacrimal glands)616

19．4．9 结膜囊腮腺管移植术(parotid duct transposition into the conjunctival sac)617

19．5．1 上泪道手术(surgery of the upper lacrimal passage)619

19．4．10 自体舌下腺移植术(sublingual glands autotransplantation)619

19．5 泪道手术(surgery of the lacrimal passages)619

19．5．2 泪囊手术(surgery of the dacryocyst)626

20 眼眶手术(orbital surgery)634

20．1 眼眶的应用解剖(applied anatomy of the orbit)634

20．1．1 眼眶骨壁及其骨膜(orbital wall and periorbit)634

20．1．2 眼外肌(extraocular muscles)635

20．1．3 眶内神经(intraorbital nerves)636

20．1．4 眼眶血管(orbital blood vessels)637

20．1．7 泪腺(lacrimal glands)638

20．1．6 眶内筋膜和手术间隙(intraorbital fasciae and operating space)638

20．1．5 眶脂肪组织(orbital adipose tissue)638

20．2 术前诊断(preoperative diagnosis)639

20．2．1 病史(case history)639

20．2．2 眼部和全身检查(examinations of the eye and system)640

20．2．3 实验室检查(laboratory examination)641

20．2．4 眼眶成像(orbital imaging)641

20．3．2 神经干阻滞(nerve trunk block)650

20．4 术中处理原则(intraoperative management principles)650

20．3．3 全身麻醉(general anesthesia)650

20．3．1 局部浸润麻醉(local infiltration anesthesia)650

20．3 麻醉(anesthesia)650

20．5 眼眶肿瘤切除术进路(surgical approaches to remove orbital tumors)651

20．5．1 前路开眶术(anterior orbitotomy)652

20．5．2 外侧开眶术(lateral orbitotomy)660

20．5．3 内侧开眶术(medial orbitotomy)665

20．5．4 经结膜进路联合外侧开眶术(transconjunctival approach combined with lateral orbito-tomy)666

20．5．5 经颅开眶术(transcranial orbitotomy)666

20．5．6 术中视觉监护(intraoperative menitoring for the vison)668

20．5．7 眶肿瘤摘除的并发症和后遗症(complications and sequels of orbital tumor removal)669

20．6．2 全眶内容剜出术(total exenteration of the orbit)670

20．6 眶内容剜出术(orbital exenteration)670

20．6．1 部分眶内容剜出术(partial exenteration of the orbit)670

20．6．3 眶内容剜出和眼眶重建术(orbital exenteration and reconstruction)672

20．7 眼眶减压术(orbital decompression)676

20．7．1 眼眶脂肪切除术(orbital fat removal)676

20．7．2 眶壁减压术(orbital wall decompression)677

20．8 视神经鞘减压术(decompression of optic nerve sheath)679

21 眼外伤手术(surgery of ocular trauma)682

21．1 眼睑外伤手术(surgery of eyelid injury)682

21．1．1 眼睑撕裂伤缝合术(suture of eyelid laceration)682

21．2 泪小管损伤手术(surgery of canaliculi injury)684

21．2．1 泪小管断裂修复术(repair of breaking canaliculus)684

21．1．2 伴皮肤缺损的眼睑撕裂伤修复术(repair of eyelid laceration with skin defect)684

21．1．3 眼睑全层缺损修复术(repair of full-thickness defect of the eyelid)684

21．2．2 陈旧性泪小管断裂修复术(repair of delayed breaking canaliculus)686

21．2．3 泪小管断裂“Z”形皮瓣修复术(repair of breaking canaliculus with Z skin flap)687

21．2．4 泪囊结膜囊吻合术(conjunctivodacryocystostomy)688

21．3 角膜表层外伤手术(surgery of superficial corneal injury)689

21．3．1 角膜上皮糜烂手术(surgery of corneal epithelial erosion)689

21．3．2 自体角膜缘移植术(limbal autografting)691

21．3．3 准分子激光治疗性角膜切削术(phototherapeutic keratectomy，PTK)692

21．3．4 非穿孔性角膜撕裂伤修复术(repair of nonpenetrating corneal laceration)693

21．4 外伤性前房积血手术(surgery of traumatic hyphema)694

21．5 虹膜睫状体损伤修复术(repair of iris and ciliary body injury)696

21．5．1 虹膜脱出的处理(management of iris prolapse)696

21．5．2 虹膜损伤的激光手术(laser surgery of iris injury)696

21．5．3 虹膜撕裂伤缝合术(suture of iris laceration)697

21．5．4 虹膜根部离断复位术(reposition of iridodialysis)698

21．5．5 外伤植入性虹膜囊肿切除术(resection of traumatic iris implantation cyst)699

21．5．7 睫状体脱离缝合术(suture of ciliary body detachment)700

21．5．6 虹膜成形术(iridoplasty)700

21．6 外伤性晶状体脱位手术(surgery of traumatic lens luxation)701

21．7 眼球穿孔伤的早期处理(early management of ocular penetrating injury)703

21．7．1 角巩膜穿孔伤修复术(repair of corneoscleral penetrating injury)703

21．7．2 外伤性白内障一期手术(early surgery of traumatic cataract)710

21．7．3 外伤性白内障晶状体切除术(lensectomy of traumatic cataract)711

21．7．4 眼球后段穿孔伤修复术(repair of penetrating injury of the posterior segment)713

21．7．5 眼球前后段复合伤修复术(repair of compound injury of the anterior and posterior seg-ments)715

21．7．6 伴严重眼内出血的眼球破裂伤修复术(repair of global rupture with severe intraocular haemorrhage)716

21．8 外伤性角膜散光的后期手术(delayed surgery of corneal wound astigmatism)716

21．8．1 角膜松弛性切开术(relaxing incision of the cornea)717

21．8．2 角膜楔状切除术(wedge resection of the cornea)718

21．9 外伤性白内障二期手术(delaye dsurgery of traumatic cataract)719

21．10 眼球前段重建术(reconstruction of the anterior segment)722

21．11 平坦部玻璃体切除术治疗眼外伤[pars plana vitrectomy(PPV)for ocular trauma]726

21．12 眼眶骨折手术(operation for fractured orbit)730

21．12．1 眶下壁骨折探查修复术(exploration and repair of fractured lower orbital wall)730

21．12．2 眶内壁骨折探查修复术(exploration and repair of fractured innerorbital wall)733

21．12．3 眶上壁骨折修复术(repair of fractured upper orbital wall)733

21．12．4 视神经管减压术(decompression of the optic nerve canal)735

21．13．1 前房穿刺和冲洗术(paracentesis and irrigation of the anterior chamber)737

21．13 眼化学伤及热烧伤手术(surgery of ocular chemical and thermal burns)737

21．13．2 球结膜切开术(bulbar conjunctivotomy)738

21．13．3 球结膜移植术(bulbar conjunctival transplantation)738

21．13．4 唇或颊粘膜移植术(transplantation of the lip or buccal mucous membrane)738

21．13．5 自体角膜缘移植术(limbal autografting)738

21．13．6 角膜上皮移植术(keratoepithelioplasty)738

21．13．7 角膜移植术(keratoplasty)738

21．13．8 睑球粘连修复术(repair of symblepharon)738

21．13．9 人工角膜成形术(prosthokeratoplasty)738

21．14 眼内异物摘除术(extraction of intraocular foreign body)738

21．14．1 前房异物摘除术(extraction of foreign body in the anterior chamber)739

21．14．2 后房异物摘除术(extraction of foreign body in the posterior chamber742

21．14．3 晶状体内异物摘除术(extraction of foreign body in the lens)743

21．14．4 睫状体异物摘除术(extraction of foreign body in the ciliary body)745

21．14．5 玻璃体内异物摘除术(extraction of foreign body in the vitreous)747

21．14．6 视网膜异物摘除术(extraction of retinal foreign body)750

22 眼成形术(oculoplastic surgery)753

22．1 概述(introduction)753

22．1．1 如何减少眼成形术后瘢痕(How to minimize postoculoplastic scar)?753

22．1．2 常用的皮片、皮瓣及组织移植(commonly used skin graft，flap and tissue transplantati-on)753

22．2 双重睑成形术(double eyelid plasty)756

22．2．1 经典切开术(classic incision technic)757

22．2．2 小切口切开术(small incision technic)758

22．2．3 缝线术(suture technic)758

22．2．4 埋线术(buried suture technic)759

22．2．5 双重睑成形术并发症(complications of double eyelid plasty)759

22．3 眼睑松弛症矫正术(blepharochalasis correction)760

22．3．1 分类(classification)760

22．3．2 上睑成形术(upper lid blepharoplasty)761

22．3．3 下睑成形术(lower lid blepharoplasty)761

22．3．5 眉下垂矫正术(correction of eyebrow ptosis)764

22．3．4 眼睑松弛矫正术并发症(complications of blepharochalasis correction)764

22．4 眦角成形术(canthoplasty)765

22．4．1 内眦赘皮矫正术(correction of epicanthus)765

22．4．2 外眦成形术(lateral canthoplasty)768

22．4．3 外眦圆钝矫正术(correction of rounded lateral canthus)768

22．4．4 外眦移位矫正术(correction of displacement of the lateral canthus)768

22．4．5 内眦韧带断离修复术(repair of medial canthal tendon breaking)769

22．5 上睑下垂矫正术(correction of ptosis)770

22．5．1 应用解剖和生理(applied anatomy and physiology)770

22．5．3 手术时机的选择(selection of operative time)771

22．5．2 病因和分类(cause and classification)771

22．5．4 术前检查(preoperative examinations)772

22．5．5 术式选择(selection of operating program)772

22．5．6 睑板-结膜-Mailer肌切除术[Fasenella-Servat术(Fasenella-Servat’s procedure)]772

22．5．7 提上睑肌缩短术(excision of the levator muscle)773

22．5．8 阔筋膜悬吊术(frontalis sling with the fascial lata)775

22．5．9 额肌筋膜瓣悬吊术(suspension with the frontalis muscle and its fascia flap)776

22．5．10 上睑下垂矫正术并发症(complications of correction of ptosis)777

22．6 眼睑退缩矫正术(correction of lid retraction)778

22．6．1 Muiler肌切除术(resection of the Mailer’s muscle)778

22．6．2 提上睑肌-Muiler肌后徙术(recession of the levator and Muiler’s muscles)779

22．7 眼睑组织缺损的修复(reconstruction of eyelid defect)780

22．7．1 眼睑浅层组织缺损修复术(reconstruction of superficial defect of the eyelid)780

22．6．3 下睑退缩矫正术(correction of lower lid retraction)780

22．7．2 眼睑全层缺损修复术(reconstruction of full thickness defect of the eyelid)781

22．8 上眶区凹陷矫正术(correction of invagination in the supraorbital region)783

22．8．1 眼内容剜出、假体植入及异体巩膜覆盖术(evisceration，prosthesis implantation and scleral cap homograft)784

22．8．2 真皮包裹义眼座植入术(implantation of prosthesis enclosed with dermis)784

22．8．3 自体骨眶内植入术(technic of autogenous bone graft into orbit)785

22．8．4 羟基磷灰石活动义眼座植入术(implantation of movable hydroxyapatite prothesis)786

22．9 睑球粘连矫正术(correction of symblepharon)788

22．9．3 唇(颊)粘膜游离移植术(oral mucous membrane graft)789

22．9．1 球结膜瓣转位术(transposition of bulbar conjunctival flap)789

22．9．2 “桥形”球结膜瓣转位术(transposition of bi-pedicle bulbar conjunctival flap)789

22．10 结膜囊重建术(reconstruction of the cul-de-sac)790

22．10．1 处理结膜囊狭窄的基本原则(basic principles of managment of cul-de-sac stenosis)790

22．10．2 下穹窿再造术(reconstruction of the low fornix)790

22．10．3 部分结膜囊重建术(reconstruction of the partial cul-de-sac)791

22．10．4 中厚皮片游离移植作全结膜囊重建术(total reconstruction of the cul-de-sac with splitthickness skin graft)791

22．11 眉提高联合大部分眼轮匝肌、降眉间肌及皱眉肌切除术(eyebrow elevation combined with resections of the orbicularis oculi，procerus and corrugator supercilli muscles)792

索引794

Index823