目的：探讨单侧内直肌截除术治疗儿童残余性和复发性外斜视的有效性及安全性，评价其在不同外斜视类型及不同初次手术方式应用的差异性。

方法：回顾性病例系列研究。收集2009-01/2013-02在山东大学附属山东省立医院行单侧内直肌截除术治疗的残余性和复发性外斜视连续性病例48例48眼，观察术后第1d， 6wk以及末次随访(术后6～32mo)时患儿眼位、眼位非共同性、融合功能及立体视锐度情况。

结果：术后第1d手术正位率为83%(40/48)，欠矫率为4%(2/48)，过矫率为13%(6/48)； 术后第6wk手术正位率为81%(39/48)，欠矫率为13%(6/48)，过矫率为6%(3/48)； 末次随访时正位率为75%(36/48)，欠矫率为25%(12/48)，无1例过矫。不同初次手术方式和不同外斜视类型患儿末次随访时手术正位率的差异均无统计学意义(P=0.168、0.50)。术后所有病例均未出现眼球运动非共同性和眼球外转受限。

结论：单侧内直肌截除术是治疗儿童残余性和复发性外斜视的安全有效术式，其在不同外斜视类型及不同初次手术方式应用的疗效无差异。

METHODS:This investigation was a retrospective case series study that examined data from 48 pediatric patients(48 eyes)who underwent unilateral medial rectus resection between January 2009 and February 2013 for residual and recurrent exotropia. We surveyed the outcome of eye alignment, lateral incomitance, fusion function, stereoacuity in children at 1d, 6wk and at last follow-up of 6-32(mean 11.99±7.06)mo after the surgery.

RESULTS: At 1d after the surgery, the rate of surgical success was 83%(40/48), and the rate of undercorrection and overcorrection was 4%(2/48)and 13%(6/48), respectively. At 6wk after the surgery, the rate of surgical success was 81%(39/48), and the rate of undercorrection and overcorrection was 13%(6/48)and 6%(3/48), respectively. At the final follow-up of 6-32(mean 11.99±7.06)mo, the surgical success rate was 75%(36/48), and the rate of undercorrection was 25%(12/48). No patient exhibited overcorrection. There were no significant differences in the surgical success rate either among pediatric patients who had previously undergone different types of surgery or among patients who had been diagnosed with different types of exotropia(P=0.168 and P=0.50, respectively). No patients presented with lateral incomitance or limited ocular motility.

CONCLUSION: Unilateral medial rectus resection is a safe and effective surgical approach for treating in children with residual and recurrent exotropia. In addition, it may achieve the same surgical effectiveness regardless of the patients' previous surgical procedures or types of exotropia.