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[脏器去除术、眼球摘除术和眶内容剜出术——适应证、技术及术后护理]

[Evisceration, enucleation and exenteration-Indications, techniques, and postoperative care].

作者信息

Kowanz Dominik H, Wawer Matos Philomena A, Gordon Erik, Doulis Alexandros, Simon Michael, Rokohl Alexander C, Heindl Ludwig M

机构信息

Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.

Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland.

出版信息

Ophthalmologie. 2023 Feb;120(2):126-138. doi: 10.1007/s00347-022-01791-4. Epub 2023 Jan 12.

Abstract

Various surgical techniques are available for the extirpation of an eye, depending on the underlying disease. Typical indications encompass tumors, inflammatory and infectious processes, glaucoma, trauma as well as congenital malformations. Surgical procedures include evisceration (resection of the intraocular space with preservation of the sclera), enucleation (extirpation of the entire eyeball including sclera and cornea) and exenteration (resection of the complete orbital soft tissue). The early detection of postoperatively manifesting complications, such as implant extrusion, conjunctivitis, postenucleation socket syndrome as well as the development of enophthalmus or ptosis, is of particular relevance in the context of postoperative care regarding functional, esthetic and social outcome. Special attention must be paid to ensuring a complication-free rehabilitation process, including the supply of a suitable, precisely fitting prosthesis or epithesis. This ensures the patient's psychosocial reintegration, in which an integrated interdisciplinary cooperation with ocularists and psychologists is essential. The latter play a particularly important role, as the psychological stress resulting from the procedure is often associated with a considerable reduction in the quality of life.

摘要

根据潜在疾病的不同,有多种手术技术可用于摘除眼球。典型的适应症包括肿瘤、炎症和感染性疾病、青光眼、外伤以及先天性畸形。手术程序包括眼内容剜除术(切除眼内空间并保留巩膜)、眼球摘除术(摘除整个眼球,包括巩膜和角膜)和眶内容剜除术(切除整个眼眶软组织)。术后早期发现明显的并发症,如植入物挤出、结膜炎、眼球摘除术后眼窝综合征以及眼球内陷或上睑下垂的发生,在术后护理的功能、美学和社会结果方面尤为重要。必须特别注意确保康复过程无并发症,包括提供合适、精确适配的假体或义眼。这确保了患者的心理社会重新融入,其中与眼科配镜师和心理学家的跨学科综合合作至关重要。后者发挥着特别重要的作用,因为手术带来的心理压力往往会导致生活质量大幅下降。

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