可调节缝线在青光眼小梁切除术中的应用
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摘要
目的探讨可调节缝线在青光眼小梁切除术中的应用及临床效果。方法选取2016年8月至2018年1月就诊的青光眼患者80例(97眼),采用随机数字表法分为对照组40例(46眼)和观察组40例(51眼),对照组给予小梁切除术,观察组在对照组基础上给予可调节缝线缝合巩膜瓣,比较两组患者术前、术后眼内压水平、两组患者术后前房深度、两组患者术后滤过泡形态和术后巩膜瓣粘连发生率。结果术后2周和术后6个月,观察组的眼内压水平明显低于对照组(P<0.01);观察组浅前房眼数明显少于对照组(P<0.05,P<0.01)。术后2周,两组的滤过泡形态比较差异无统计学意义(χ~2=0.264,P=0.607);术后6个月,观察组的功能性滤过泡率明显高于对照组(94.12%vs 78.26%,χ~2=5.240,P=0.022)。术后2周,观察组患者无巩膜瓣粘连发生,对照组患者巩膜瓣粘连发生率为2.17%(1/46),两组比较差异无统计学意义(P>0.05);术后6个月,观察组患者巩膜瓣粘连发生率明显低于对照组(3.92%vs 19.57%,χ~2=5.887,P=0.015)。结论可调节缝线在青光眼小梁切除术中的应用效果较好,安全可靠。
Objective To explore the application and clinical effect of adjustable suture in trabeculectomy for glaucoma.Methods Eighty patients(97 eyes) with glaucoma from August 2016 to January 2018 were selected and randomly divided into control group(n=40,46 eyes) and observation group(n=40,51 eyes).The trabeculectomy was performed in control group,while the adjustable sutured scleral flap was added in observation group.Intraocular pressures before and after operation,anterior chamber depth,the morphology of filtering bleb and incidence of scleral flap adhesion after operation were compared between two groups.Results At 2 weeks and 6 months after operation,the intraocular pressure in the observation group was significantly lower than that in the control group(P<0.01),and the number of shallow anterior chamber eyes in observation group was significantly less than that in control group(P<0.05,P<0.01).Two weeks after operation,there was no significant difference in the morphology of filtering blebs between two groups(χ~2=0.264,P=0.607),but the functional filtering bleb formation rate in observation group was significantly higher than that in control group at 6 months after operation(94.12% vs 78.26%,χ~2=5.240,P=0.022).Two weeks after operation,there was no significant difference in scleral flap adhesion between obervation group and control group(0 vs 2.17%,P=0.474).At 6 months after operation,the incidence of scleral flap adhesion in observation group was significantly lower than that in control group [3.92%(2/51)vs 19.57%(9/46),χ~2=5.887,P=0.015].Conclusion The application of adjustable suture in trabeculectomy for glaucoma is safe and reliable.
Objective To explore the application and clinical effect of adjustable suture in trabeculectomy for glaucoma.Methods Eighty patients(97 eyes) with glaucoma from August 2016 to January 2018 were selected and randomly divided into control group(n=40,46 eyes) and observation group(n=40,51 eyes).The trabeculectomy was performed in control group,while the adjustable sutured scleral flap was added in observation group.Intraocular pressures before and after operation,anterior chamber depth,the morphology of filtering bleb and incidence of scleral flap adhesion after operation were compared between two groups.Results At 2 weeks and 6 months after operation,the intraocular pressure in the observation group was significantly lower than that in the control group(P<0.01),and the number of shallow anterior chamber eyes in observation group was significantly less than that in control group(P<0.05,P<0.01).Two weeks after operation,there was no significant difference in the morphology of filtering blebs between two groups(χ~2=0.264,P=0.607),but the functional filtering bleb formation rate in observation group was significantly higher than that in control group at 6 months after operation(94.12% vs 78.26%,χ~2=5.240,P=0.022).Two weeks after operation,there was no significant difference in scleral flap adhesion between obervation group and control group(0 vs 2.17%,P=0.474).At 6 months after operation,the incidence of scleral flap adhesion in observation group was significantly lower than that in control group [3.92%(2/51)vs 19.57%(9/46),χ~2=5.887,P=0.015].Conclusion The application of adjustable suture in trabeculectomy for glaucoma is safe and reliable.
引文
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[8] 黄瑶,荣世松,孟海林,等.小梁切除术术中房水滤过量与术中及术后早期眼压无关[J].眼科,2014,23(2):94-98.
[9] Sofi RA,Shafi S,Qureshi W,et al.Merits of trabeculectomy in advanced and end-stage glaucoma[J].Int J Health Sci (Qassim),2018,12(2):57-60.
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[11] 汤晓东.复合式与传统小梁切除术治疗青光眼疗效的比较[J].医学综述,2014,20(17):3260-3262.
[12] 钱韶红.青光眼滤过性手术后浅前房的原因识别及相关处理[J].中国眼耳鼻喉科杂志,2016,16(3):156-159.
[13] 董仕婷.可调节缝线在滤过性抗青光眼手术中的应用[J].医药前沿,2014(10):271-272.
[14] 贺志华,张丽.可调节缝线在青光眼滤过术中的应用研究[J].国际眼科杂志,2014,14(10):1868-1870.
[15] 韩冬,卢文胜,王晓冰,等.76例急性闭角型青光眼持续高眼压下行抗青光眼手术的临床效果评价[J].临床眼科杂志,2016,24(2):127-129.
[16] 杨梅,范义朋,韩民.可调节缝线对持续高眼压状态下青光眼术后控制眼压的疗效研究[J].当代医学,2014,20(30):81-82.
[17] 宁科伟.可调式缝线法预防青光眼滤过术后早期浅前房的临床研究[J].河南职工医学院学报,2014,26(6):661-662.
[18] 王娟.小梁切除联合羊膜移植术对青光眼患者眼压及滤过泡形成的影响[J].河南外科学杂志,2018,24(2):93-95.
[2] 颜雪峰.青光眼手术治疗的研究进展[J].中国实用眼科杂志,2015,33(3):227-230.
[3] 曹志杰,顾丽萍,吴作志,等.复合式小梁切除术治疗青光眼的并发症及疗效观察[J].国际眼科杂志,2017,17(1):98-100.
[4] 贺玮,于建国,齐世欣.巩膜瓣缝线跨度对小梁切除术后眼压及功能性滤过泡形成的影响[J].山东医药,2016,56(18):72.
[5] 陈书扬,邝国平,朱俊东,等.可调节缝线在 Ahmed青光眼阀植入术治疗新生血管性青光眼的临床应用[J].临床眼科杂志,2015,23(2):150-151.
[6] 李静,朱德军,哈少平.UBM检查对抗青光眼外滤过术后滤过泡形态与眼压关系的观察及分析[J].宁夏医学杂志,2015,37(5):428-430.
[7] 戴毅,孙兴怀.从流行病学角度认识青光眼的特点与危害[J].中国眼耳鼻喉科杂志,2016,16(3):179-181.
[8] 黄瑶,荣世松,孟海林,等.小梁切除术术中房水滤过量与术中及术后早期眼压无关[J].眼科,2014,23(2):94-98.
[9] Sofi RA,Shafi S,Qureshi W,et al.Merits of trabeculectomy in advanced and end-stage glaucoma[J].Int J Health Sci (Qassim),2018,12(2):57-60.
[10] 李红梅,郝燕燕.青光眼小梁切除术后再次手术的临床观察[J].中华眼外伤职业眼病杂志,2014,36(4):280-282.
[11] 汤晓东.复合式与传统小梁切除术治疗青光眼疗效的比较[J].医学综述,2014,20(17):3260-3262.
[12] 钱韶红.青光眼滤过性手术后浅前房的原因识别及相关处理[J].中国眼耳鼻喉科杂志,2016,16(3):156-159.
[13] 董仕婷.可调节缝线在滤过性抗青光眼手术中的应用[J].医药前沿,2014(10):271-272.
[14] 贺志华,张丽.可调节缝线在青光眼滤过术中的应用研究[J].国际眼科杂志,2014,14(10):1868-1870.
[15] 韩冬,卢文胜,王晓冰,等.76例急性闭角型青光眼持续高眼压下行抗青光眼手术的临床效果评价[J].临床眼科杂志,2016,24(2):127-129.
[16] 杨梅,范义朋,韩民.可调节缝线对持续高眼压状态下青光眼术后控制眼压的疗效研究[J].当代医学,2014,20(30):81-82.
[17] 宁科伟.可调式缝线法预防青光眼滤过术后早期浅前房的临床研究[J].河南职工医学院学报,2014,26(6):661-662.
[18] 王娟.小梁切除联合羊膜移植术对青光眼患者眼压及滤过泡形成的影响[J].河南外科学杂志,2018,24(2):93-95.