作者：苏玉英，袁昱，马宁
作者单位：（723000）中国陕西省汉中市中心医院眼科
【摘要】目的：单纯应用可调整缝线的小梁切除术与复合式小梁切除术的术后疗效及并发症的比较。
方法：原发性开角型青光眼（POAG)或原发性闭角型青光眼（PACG）182例（226眼），其中实验组98例（130眼），对照组84例（96眼），实验组单纯应用可调整缝线的小梁切除术，对照组复合式小梁切除术（采用丝裂霉素C联合可调整缝线的小梁切除术），并对手术疗效，手术并发症进行对照分析。
结果：两组术后眼压控制理想，但术后浅前房、低眼压、前房出血的发生率实验组明显低于对照组，差异具有统计学意义（P＜0.05）。
结论:复合式小梁切除术疗效确切，但术后浅前房、低眼压与前房出血的发生率较高，而单纯应用可调整缝线的小梁切除术不仅疗效确切，且术后浅前房、低眼压与前房出血的发生率明显降低。
【关键词】 可调整缝线；复合式；小梁切除术；青光眼
Clinical effect comparison of two kinds of glaucoma trabeculectomise
YuYing Su, Yu Yuan, Ning Ma
Department of Ophthalmology, Central Hospital of Hanzhong City, Hanzhong 723000, Shaanxi Province, China
Correspondence to: YuYing Su.Department of Ophthalmology, Central Hospital of Hanzhong City, Hanzhong 723000, Shaanxi Province, [email protected]
AbstractAIM: To comparethe postoperative curative effect and the complication incidence of simple adjustable sutured trabeculectomy and compound trabeculectomy. METHODS: Totally 182 cases (226 eyes) with primary open angle glaucoma (POAG) or primary angleclosure glaucoma (PACG) were divided into experimental group (130 eyes of 98 cases) and control group (96 eyes of 84 cases). Simple adjustable sutured trabeculectomy was applicated on eyes in experimental group, and eyes in control group were given compound trabeculectomy (mitomycin C + adjustable sutured trabeculectomy). The curative effect and complication incidence were compared postoperatively.RESULTS: Postoperatively IOPs were similar in two group, but the incidences of shallow anterior chamber, hypotony and hyphema in experimental group were obviously lower than those of control group, which had statistical significance (P<0.05).CONCLUSION: Compound trabeculectomy is characterized by obvious curative effect, and higher incidences of shallow anterior chamber, hypotony and hyphema. However, simple adjustable sutured trabeculectomy is featured not only definite therapeutic effect, but also lower incidences of those complications.
KEYWORDS: adjustable suture; compound; trabeculectomy; glaucoma
0引言
复合式小梁切除术应用于青光眼滤过手术以来，取得了较高的成功率，但术中使用抗代谢药物，增加了术后的并发症，我院自2004年将常规小梁切除术改为应用可调整缝线的小梁切除术并与复合式小梁切除术对比，发现明显减少了术后并发症。我们将近4a两组术后疗效和手术并发症进行了回顾性分析。
1对象和方法
1.1对象
我院自从2003/2006年因原发性开角型青光眼（POAG）或原发性闭角型青光眼（PACG）而接受小梁切除术的病例共182例（226眼）。分为单纯应用可调整缝线的小梁切除术组（实验组）98例（130眼）和复合式小梁切除术组（对照组）84例（96眼）。实验组患者平均年龄61岁，男45例，女53例，POAG 59眼（45.4%），PACG 71眼（54.6%），术前平均眼压41.5mmHg。对照组患者平均年龄59.8岁，男43例，女41例，POAG 38眼（39.6%），PACG 58眼（60.4%），术前平均眼压38.18mmHg。
1.2方法
实验组在常规方法行小梁除术的基础上用10/0尼龙线在巩膜瓣两侧作两条可调整缝线打活结，两侧活结引线分别从离角巩缘0.4~0.5cm处的10点位、2点位球结膜下引出，引出线不少于0.6cm。术毕房水滤过量合适，前房形成，根据术后眼压、前房形成是否稳定、滤过泡形态功能情况，于术后3~14d在表面麻醉、裂隙灯下分次拆除可调整缝线。对照组术中于巩膜瓣下放置含抗代谢药物丝裂霉素C 0.2～0.3g/L棉片3～5min后将棉片丢弃，丝裂霉素C放置时间长短及浓度高低根据患者年龄、结膜厚度及充血、Tenon囊厚度情况而定。迅速用100～120mL平衡盐溶液冲洗巩膜瓣，巩膜瓣可调整缝线的缝合同实验组。术后3d~1mo在表麻、裂隙灯下分次拆除可调整缝线。两组均观察术前术后眼压，术后前房深度及浅前房持续时间、前房出血、滤过泡形态分型及住院时间。
统计学处理：两组间的年龄、眼压、浅前房持续时间、住院时间均数的比较采用t检验，术后并发症发生率的比较采用χ2检验。
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