目的:评估超脉冲二氧化碳(CO2)激光治疗不同类型眼睑肿物的疗效和安全性。方法:纳入50例眼睑肿物患者,其中男12例、女38例。患者年龄4~84岁。肿物类型包括眼睑色素痣、睑黄瘤、分裂痣、眼睑疣等,其中25例累及眼睑灰线,10例肿物直径>10 mm。所有患者接受超脉冲CO2激光治疗,并进行术后随访。治疗效果通过术后数码照片评估,同时记录术后1个月并发症发生情况。结果:50例眼睑肿物总体治愈率为92%,有效率达到100%。4例眼睑色素痣在治疗后1个月内复发。术后并发症主要包括轻微倒睫(5例)、睫毛稀疏部分缺失(4例)和瘢痕增生及色素沉着(4例),未出现其他严重并发症。结论:对于眼睑肿物,特别是睑缘肿物及大肿物,超脉冲CO2激光是一种更为精确、微创、安全有效的治疗方法,可作为眼睑肿物治疗的优选方案。
Objective: To evaluate the efficacy and safety of ultrapulse carbon dioxide (CO2) laser in the treatment for various types of eyelid tumors. Methods: A total of 50 patients, including 12 males and 38 females,with eyelid tumors were included in the study The age range is from 4 to 84 years, with an average age of 37.9±20.0 years. The tumors found in our study include eyelid pigmented nevus, xanthelasma, divided nevus, and molluscum. Among them, 25 cases involved the gray line of the eyelid,and 10 cases had a tumor diameter greater than 10 mm. All patients underwent ultrapulse CO2 laser treatment and postoperative follow-up. The treatment outcomes were assessed through digital photos, and complications were recorded one month after surgery. Results: The total cure rate of the 50 cases of eyelid tumors in our study was 92%, with the effective rate reaching 100%. 4 cases of eyelid pigmented nevi recurred within one month after treatment, while all other patients were cured. Postoperative complications mainly included minor trichiasis (5 cases), partial sparse to absent eyelashes (4 cases), and hypertrophic scar with hyperpigmentation (4 cases). No other serious complications were reported in our study. Conclusions: For eyelid tumors, especially eyelid margin and larger tumors, the ultrapulse CO2 laser is a more precise, minimally invasive, safe and effective treatment method. It can be used as a preferred treatment option for eyelid tumors, and should be promoted widely in clinical practice.
目的:调查临床医学5年制本科生对见习教学的满意度,并分析其影响因素。方法:采用匿名线上问卷调查,向中山大学2019级临床医学5年制4年级的结束所有临床科室见习的本科生发放见习满意度问卷。结果:共有75人完成了问卷调查。在最满意的见习课程中,眼科学见习满意度最高(39人,52%),其次是外科学(18人,24%)和内科学(7人,9.33%)。教学满意度的影响因素综合得分排名前5位的选项分别是“A课程设置合理,临床见习重点突出”“B见习小课授课水平高”“C师资配备好,小组教学”“D临床资源丰富,利于见习教学”以及“E教学方法先进,方式灵活多样,新型教学形式丰富”。在选择排序第一(B 33.33%,A 25.86%,E 21.15%)和第二(E 26.92%,B 24.56%,A 24.14%)的影响因素时,前三位的选项均为A、B、E,学生对见习课程设置、见习小课水平和见习教学方式、方法非常重视。在学生从事眼科专业的意愿方面,5人(6.67%)表示非常愿意、32人(42.67%)表示有可能今后从事眼科专业,二者比例合计与眼科学获得最满意见习课程的比例非常接近。结论:见习课程设置、小课授课水平以及见习教学的方式、方法是见习教学满意度的重要影响因素。临床见习的满意度对学生的职业导向具有一定的影响。
Objective: To investigate the satisfaction of 5-year undergraduate students in clinical medicine with clerkship teaching and analyze its influencing factors. Methods: Anonymous online questionnaire survey was conducted. Satisfaction questionnaires were distributed to undergraduate students in the 4th year of the 5-year clinical medicine at Sun Yat- sen University who had completed clerkship in all clinical departments. Results: A total of 75 students completed the questionnaire survey. Among the most satisfactory clerkship courses, ophthalmology had the highest satisfaction rate (39 votes, 52%), followed by surgery (18 votes, 24%) and internal medicine (7 votes, 9.33%). Te top 5 options in terms of comprehensive scores for infuencing factors of teaching satisfaction are "A. Reasonable curriculum with prominent focuses", "B. High clerkship class teaching level", "C. Strong teaching staf", "D. Abundant clinical resources ", and "E. Advanced teaching methods ". When selecting the infuencing factors that rank frst (B 33.33%, A 25.86%, E 21.15%) and second (E 26.92%, B 24.56%, A 24.14%), the top three options are A, B, and E. Students atach great importance to the seting of clerkship courses, the level of clerkship courses, and the teaching methods. In terms of students' willingness to engage in ophthalmology, 5 students (6.67%) expressed great willingness, and 32 students (42.67%) expressed the possibility. Conclusions: Te seting of clerkship courses, the level of small class teaching, and the clerkship teaching method are important infuencing factors of clerkship satisfaction. Te satisfaction of clerkship has a certain impact on students' career selection.
目的:评价上睑下垂矫正术后并发上睑内翻倒睫的手术治疗效果,并分析其发生原因。方法:回顾性分析2015年1月1日至2020年6月30日因上睑下垂矫正术后并发上睑内翻倒睫在中山大学中山眼科中心接受手术治疗,随访时间6个月以上的患者资料。患者的内翻倒睫矫正手术方案根据有无合并上睑下垂过矫或者欠矫,以及原上睑下垂矫正的矫正方式进行设计。评价术前、术后患者的睑裂高度、眼睑闭合不全程度、上睑睑缘弧度、内翻倒睫矫正状态和角膜荧光素染色评分。结果:本研究共收录上睑下垂术后并发上睑内翻倒睫患者19例(20眼),其中额肌肌瓣悬吊术后17例(18眼:上睑过矫8眼,欠矫6眼,睑裂高度正常4眼),提上睑肌缩短术后2例(2眼:上睑过矫1例,欠矫1例)。所有患者的上睑内翻倒睫经手术治疗均完全矫正,角膜上皮荧光素染色评分显著降低(P<0.05)。上睑下垂过矫或欠矫术后均矫正满意,术前睑裂高度正常的患者矫正内翻倒睫没有改变睑裂高度。总结术中探查所见,上睑下垂矫正术后发生上睑内翻倒睫可能与多个因素相关:上睑皮肤切口位置过低;睑缘眼轮匝肌去除过多;额肌肌瓣分离不佳;额肌肌瓣在睑板上的固定位置过高;术中对睑裂高度评估不准确引起上睑下垂过矫等。结论:上睑下垂矫正术后并发上睑内翻倒睫再次手术可以达到满意的治疗效果,但手术操作较为棘手。为降低此类并发症的发生和患者多次手术的风险,应规范上睑下垂矫正手术操作,总结教训。
Objective: To evaluate the surgical treatment outcome of upper eyelid entropion after ptosis correction and analyze the complicated causes. Methods: A retrospective analysis was performed on patients who underwent surgical treatment for complicated upper eyelid entropion after ptosis correction and were followed up for more than 6 months at Zhongshan Ophthalmic Center from January 1, 2015 to June 30, 2020. Pre- and postoperative lid height, lagophthalmos, upper lid margin curvature, eyelid entropion and corneal fluorescein staining scoreswere evaluated. Results: A total of 18 cases (19 eyes) were included, among which 17 cases (18 eyes: 8 eyes of ptosis overcorrection, 6 eyes of ptosis undercorrection, and 4 eyes with normal eyelid height) were post-frontalis flap suspension, and 2 cases (2 eyes: 1 eye of ptosis undercorrection, 1 eye of ptosis overcorrection) post-levator resection. All patients had a complete correction of upper eyelid entropion and a significant reduction in corneal epithelial fluorescein staining score (P<0.05). Both the complicated ptosis undercorrection and overcorrection were treated with satisfactory outcome. Correction of entropion did not change the eyelid height in patients with preoperative normal height. The intraoperative findings showed that several factors related to original ptosis surgery may be involved in complicated upper eyelid entropion, including: the skin incision too close to the upper lid margin, excessive resection of the orbicularis oculi muscle along the eyelid margin, poor separation of the frontalis muscle flap, inappropriate eyelid plate fixation site of the frontalis muscle flap, and ptosis overcorrection caused by inaccurate evaluation of the intraoperative eyelid height, etc. Conclusion: Surgical treatment of the upper eyelid entropion secondary to ptosis correction is safe and effective, but is complicated and difficult. Skillful ptosis surgery and appropriate surgical techniques are crucial to reduce its occurrence.
目的:利用儿童Glasgow受益调查问卷(Glasgow Children’s Benefit Inventory,GCBI)评估先天性上睑下垂手术后儿童健康相关生活质量(health-related quality of life,HRQOL)的受益,并探索受益的影响因素。方法:验证GCBI中文版评估先天性上睑下垂矫正术后长期患儿生活质量的信效度,并用其评估术后儿童HRQOL受益与性别、手术年龄、术后随访时间等相关性。结果:共178名先天性上睑下垂接受下垂矫正术后儿童完成问卷,结果显示不同性别、年龄均有正性受益,术后短期(<1年)受益更明显(P<0.05)。结论:GCBI中文版具有良好的信度和效度,适用于评估先天性上睑下垂儿童术后受益结果。先天性上睑下垂儿童接受下垂矫正术后不同性别均有正性受益,术后短期(<1年)受益更明显。
Objective: To explore the benefits of children’s HRQOL after congenital ptosis surgery using the Glasgow Children’s Benefit Inventory (GCBI) and the factors influencing the benefits. Methods: To verify the reliability and validity of the Chinese version of GCBI in evaluating the long-term life quality of children after correction of congenital ptosis, and to evaluate the correlation between the HRQOL benefit of children after surgery and gender, surgical age, postoperative follow-up time, etc. Results: A total of 178 children after congenital ptosis surgery completed the questionnaire. Different genders or ages of children with congenital ptosis both showed positive benefit after ptosis correction, and the short-term (<1 year) benefit was more obvious after surgery (P<0.05). Conclusion: The Chinese version of GCBI has good reliability and validity,and is suitable for evaluating the postoperative benefit results of children with congenital ptosis. All the children with congenital ptosis received positive benefit after ptosis correction, and the short-term benefit (<1 year) was more obvious.
目的:评价手术视频辅助Wetlab眼睑手术教学的效果。方法:回顾性分析2021年4月至2021年9月在中山大学中山眼科中心住院医师规范化培训学员中使用全眼模型开展Wetlab外眼手术教学的情况。对照组(12人)采用传统教学方法,实验组(15人)在传统教学方法的基础上引入手术视频辅助教学,对学员第3、6、9次练习视频进行评分,分析教学效果。结果:2组学员的基线水平与学习曲线相似,练习第3次到第6次之间评分提高快(对照组P3~6=0.001,实验组P3~6<0.001),第6次到第9次之间提高速度放缓(对照组P6~9=0.007,实验组P6~9=0.012)。对照组学员在练习第3次用时更长[(80.3±16.1) min],随着练习次数增多,用时逐渐缩短并保持稳定(P3~6=0.040,P6~9=0.886,P3~9=0.020),而实验组学员在练习第3次用时更短[(71.7±15.0) min],练习过程中保持稳定(P3~6=0.568,P3~9=0.519)。结论:手术视频辅助教学有助于学员熟悉手术操作,提高练习效率。
Objective: To assess the efficacy of video-assisted Wetlab eyelid surgery teaching. Methods: From April 2021 to September 2021, the porcine orbit model was used to conduct a Wetlab teaching course on eyelid surgeries among trainees of standardized training for residents in Zhongshan Ophthalmic Center, Sun Yat-sen University. The control group (12 trainees) used conventional teaching methods. Video-assisted teaching was offered to the test group (15 trainees) based on conventional teaching methods. The videos records of the 3rd, 6th, and 9th practices were scored to analyze the teaching efficiency. Results: Trainees from the 2 groups showed a simila baseline and learning curve. Rapid improvement was found between the 3rd and 6th practice (P3–6=0.001 in control group, P3–6<0.001 in test group). The increment was slower between the 6th and 9th practice (P6–9=0.007 from control group, P6–9=0.012 from test group). Longer time was required by trainees from the control group at the 3rd practice [(80.3±16.1) min]. As they practiced more, the time required gradually decreased and remained stable (P3–6=0.040, P6–9=0.886, P3–9=0.020 from control group). Trainees from the test group spent less time at the 3rd practice [(71.7±15.0) min]. The time remained stable during all practices (P3–6=0.568, P3–9=0.519 from test group). Conclusion: Video-assisted teaching can help trainees get familiar with surgical operations and improve the efficiency of practices.