作者：吕明,孔凡宏,刘建华,任淑兰 作者单位：101149）中国北京市通州区潞河医院眼科
【摘要】 目的：观察复合式小梁切除术及传统小梁切除术术后浅前房的发生率及在眼压的控制和功能性滤过泡的维持上是否存在差异。
【关键词】 复合式小梁切除术；传统小梁切除术;青光眼
Clinical observation of compound trabeculectomy and traditional trabeculetomy for primary angleclosure glaucoma Ming Lü, FanHong Kong, JianHua Liu, ShuLan Ren Department of Ophthalmology, Luhe Hospital of Beijing Tongzhou District, Beijing 101149, China Abstract AIM: To compare the postoperative occurrences of shallow anterior chamber, ophthalmotonic control and maintenance of functional filterling belbs between compound trabeculectomy and traditional trabeculetomy in treating primary angleclosure glaucoma.
METHODS: One hundred and eightyfive cases(207 eyes) with primary angleclosure glaucoma were divided into two groups. Group A: 74 cases(81 eyes) underwent traditional trabeculetomy. Group B: 111 cases(126 eyes) underwent compound trabeculectomy. The incidence rate of shallow anterior chamber and the control of intraocular pressure(IOP) one week after operation were compared and analyzed, so were the the control of IOP and maintenance of functional filterling belbs one year after followup.
RESULTS: The incidence rate of shallow anterior chamber one week after operation was 19.8％ in group A and 8.7％ in group B, and the difference was significant between the two groups（ χ2＝5.28,P<0.05）. The control rate of IOP one week after operation was 88.9％ in group A and 85.7％in group B, and the difference was not significant between the two groups（χ2＝0.43）, but after one year followup the control rate was 73.0％in group A and 90.2％ in group B, and the difference was significant between the two groups（χ2＝6.83,P<0.01）. The maintenance rate of functional filterling belbs was 80.8％ in group A and 92.7％ in group B, and the difference was significant between the two groups（χ2＝4.30,P<0.05）.
CONCLUSION: The compound trabeculectomy is better than traditional trabeculetomy in keeping the depth of postoperative anterior chamber, and the longterm effect of IOP control and functional filterling belbs maintenance seems to be good.
KEYWORDS: compound trabeculectomy; traditional trabeculetomy; glaucoma
方法：回顾分析A组74例81眼行传统小梁切除术的患者和B组111例126眼行复合式小梁切除术的患者，比较两者在术后1wk内浅前房的发生率，眼压的控制及两组中部分患者术后随访1a眼压的控制及功能性滤过泡的维持情况。并作统计学分析。 结果：术后1wk浅前房的发生率A组19.8％，B组8.7％，两组统计学上差异显著（χ2＝5.28，P<0.05） 术后1wk眼压控制率A组88.9％，B组85.7％，两组统计学上无显著差异（χ2＝0.43），随访术后1a眼压的控制率A组73.0％，B组90.2％，两组统计学差异显著（χ2＝6.83，P<0.01），功能性滤过泡的比率A组80.8％，B组92.7％，两组统计学上差异显著（χ2＝4.30，P<0.05）。 结论：复合式小梁切除术较传统小梁切除术能更好的维持术后正常的前房，从而避免由此导致的并发症，且远期控制眼压及维持功能性滤过泡效果良好。0引言
青光眼是眼科临床常见的致盲性眼病，且如果因持续高眼压导致视神经损害后视力常无法恢复，在我国青光眼主要以原发性闭角型青光眼为主，小梁切除术作为经典的抗青光眼滤过性手术自运用到临床以来在控制眼压维持视功能方面疗效确切，但该手术也存在术后早期持续性浅前房，低眼压，部分患者由于滤过道内成纤维细胞的增殖及产生胶原纤维导致瘢痕化使滤过泡失效等并发症。为降低上述并发症，近年来，传统小梁切除术中联合应用巩膜瓣可调节缝线及应用抗代谢药物的复合式小梁切除术越来越多的应用到抗青光眼的治疗中。我们回顾分析了200407/200807间在我院行传统小梁切除术及复合式小梁切除术的原发性闭角型青光眼患者，将两者在控制眼压，术后浅前房的发生，及维持功能性滤过泡等方面做一比较分析，现将分析结果报告如下。
1对象和方法
1.1对象 纳入本次分析的均为200401/200807在我院确诊并行手术治疗的原发性闭角型青光眼的患者共185例207眼，根据手术方式不同分为A，B两组。A组术式为传统小梁切除术74例81眼，急性闭角型青光眼62例，慢性闭角型青光眼12例，男性患者23例，女性患者51例，平均年龄65.2岁，术前眼压13.23～52.32（平均28.82）mmHg，B组术式为复合式小梁切除术111例126眼，急性闭角型青光眼82例，慢性闭角型青光眼29例，男性患者27例，女性患者84例，平均年龄69.5岁，术前眼压14.65～58.23（平均31.16）mmHg。
1.2方法 传统小梁切除术：倍诺喜表面麻醉，利多卡因球周及结膜下浸润麻醉，上直肌牵引缝线，做以穹隆为基底的结膜瓣，结膜瓣偏向鼻侧或颞侧，暴露的巩膜烧灼止血，以角膜缘为基底做5mm×4mm 1/2厚度的长方形巩膜瓣，前分离至清亮角膜区内1mm，切除巩膜瓣下1.5mm×2mm的小梁组织，并做相应部位的虹膜周边切除，整复巩膜瓣，10/0尼龙线缝合巩膜瓣顶端两针，并于球结膜切口的两端角巩膜处各缝合一针，下方球结膜下注射妥布霉素2万U，地塞米松2.5mg，涂10g/L阿托品眼膏。复合式小梁切除术：基本步骤同传统小梁切除术，但在手术过程中，巩膜瓣制做完毕后，用0.2～0.4mg/mL的丝裂霉素C浸泡的与巩膜瓣大小相当的棉片置于巩膜瓣下1.5～2min后取走棉片，用60～100mL的生理盐水反复冲洗手术区，颞侧角膜缘1mm处15°穿刺刀做前房穿刺口，巩膜瓣两顶端缝合完毕后，两侧边做一对可拆除的巩膜瓣缝线，外露端从角膜缘内1mm的透明角膜穿出，在缝线打结前，经前房穿刺口注入平衡盐重建前房，根据房水从巩膜瓣下渗漏的情况调整缝线松紧，以产生合适的房水滤出，最后以活结结扎调节缝线。术后处理：术后常规点典必殊抗炎预防感染，复方托品酰胺散瞳，根据前房形成情况，滤过泡形态及眼压的情况选择合适时机拆除调节缝线。比较两组患者术后1wk内浅前房发生数及眼压控制情况。部分患者术后随访1a，并比较1a后两组眼压控制及功能性滤过泡的情况。
统计学分析：对所获得的计数资料进行χ2检验。
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