目的：研究巩膜扣带术(scleral buckling，SB)联合玻璃体注气术治疗孔源性视网膜脱离(rhegmatogenous retinal detachment，RRD)的临床疗效及对患者血清中氨基酸、血管内皮生长因子(vascular endothelial growth factor，VEGF)的影响。

方法 ：回顾性分析我院收治的RRD患者150例150眼临床资料，将仅接受SB的患者81例81眼纳入未注气组，接受SB+玻璃体注气术的患者69例69眼纳入注气组，比较两组患者手术疗效和术前、术后血清中氨基酸、VEGF水平等情况。

结果：两组患者术后各时间点视网膜复位率比较，差异均无统计学意义(P>0.05)； 注气组术后1d眼压明显高于未注气组，差异有统计学意义(P<0.05)，两组患者术后5d眼压比较差异无统计学意义(P>0.05)； 两组患者术后术眼裸眼视力较术前均明显改善，差异有统计学意义(P<0.05)； 术后5d，两组患者血清中组氨酸、谷氨酸、苯丙氨酸、VEGF水平较术前均显著降低，差异有统计学意义(P<0.05)，但组间比较差异无统计学意义(P>0.05)； 两组患者血清中精氨酸、亮氨酸、异亮氨酸、甘氨酸水平与术前比较，差异无统计学意义(P>0.05)； 术后1mo，两组患者视功能相关生活质量总分和各维目评分均较术前明显升高，差异有统计学意义(P<0.05)，但两组间各评分比较差异无统计学意义(P>0.05)； 注气组术后并发症总发生率为7.2%(5/69)与未注气组的9.9%(8/81)比较，差异无统计学意义(P>0.05)。

结论：SB联合玻璃体注气术有助于RRD患者视功能和眼压的早期恢复，降低血清中组氨酸、谷氨酸、苯丙氨酸、VEGF水平，且安全性较高。

METHODS: The clinical data of 150 RRD patients(150 eyes)in our hospital were retrospectively analyzed. And 81 patients(81 eyes)treated with scleral buckling alone were included into the non-gas injection group while 69 patients(69 eyes)treated with scleral buckling combined with intravitreous gas injection were included in the gas injection group. The surgical effect, serum levels of amino acids and VEGF before and after surgery were compared between the two groups.

RESULTS: There was no significant difference in retinal reattachment rate between the two groups at different time points after surgery(P>0.05). The intraocular pressure of gas injection group at 3d after surgery was significantly higher than that of non-gas injection group(P<0.05)but there was no significant difference in intraocular pressure between the two groups at 5d after surgery(P>0.05). The uncorrected visual acuity of operative eye of the two groups was improved significantly after surgery(P<0.05). Serum levels of histidine, glutamic acid, phenylalanine and VEGF levels in the two groups significantly decreased at 5d after surgery(P<0.05), without significant difference between the two groups(P>0.05). There was no significant difference in serum levels of arginine, leucine, isoleucine and glycine before and after treatment(P>0.05). The total score of visual function related quality of life and scores of different dimensions significantly increased at 1mo after surgery(P<0.05), without significant differences between the two groups(P>0.05). There was no significant difference in the total incidence of postoperative complications between the gas injection group(7.2%, 5/69)and the non-gas injection group(9.9%, 8/81; P>0.05).

CONCLUSION: Scleral buckling combined with intravitreous gas injection can help the early recovery of visual function and intraocular pressure in RRD patients, and reduce the levels of histidine, glutamic acid, phenylalanine and VEGF, and it has high safety.