抗增殖药物浸泡生物羊膜在小梁切除术中的应用  

Application of biological amniotic membrane immersed in anti-proliferative drug during trabeculectomy

作　　者：张晨明[1,2] 郭百灵[1,2] 王建荣[1,2] 王玉[1,2] 

机构地区：[1]济南市第二人民医院,山东省济南市250001 [2]济南眼科医院眼科

出　　处：《眼科新进展》2010年第2期144-146,共3页Recent Advances in Ophthalmology

基　　金：济南市卫生科技计划基金资助(No:2008013)~~

摘　　要：目的探讨抗增殖药物浸泡生物羊膜应用于青光眼小梁切除术中的临床疗效。方法采用随机对照的方法,将本院2006年10月至2007年5月收治的64例(97眼)原发性青光眼患者分为单纯羊膜组20例28眼(A组),药物浸泡组24例35眼(B组),丝裂霉素组20例34眼(C组)。A组施行小梁切除术联合巩膜瓣下生物羊膜植入术;B组小梁切除术联合巩膜瓣下放置经5-氟尿嘧啶浸泡的生物羊膜;C组在小梁切除术中巩膜瓣上、下一次性应用0.4g.L-1丝裂霉素C,时间3min。术后均随访12个月,比较3种手术方式的临床疗效。结果术后随访12个月,与术前相比,3组眼压均明显降低(均为P<0.05),术后12个月复查眼压仍控制在21mmHg(1kPa=7.5mmHg)以下者A组占67.9%,B组占85.7%,C组占73.5%,B组与其余两组比较及A、C组之间差异均有显著统计学意义(均为P<0.01);术后1周内视力提高或不变者C组占61.8%(平均提高1.1行),而A、B组分别为89.3%(平均提高1.5行)、88.6%(平均提高1.6行);超声生物显微镜随访发现B组患者滤过腔隙较A和C组维持明显,B组能更长时间的保持功能性滤过泡;3组术后角膜内皮细胞计数C组较A、B组明显减少(均为P<0.05)。结论将抗增殖药物浸泡的生物羊膜应用于青光眼小梁切除术可有效防止滤过泡的瘢痕组织形成,并发症较术中应用丝裂霉素C少,是治疗青光眼安全、有效的手术方式。Objective To investigate the clinical efficacy of biological amniotic membrane immersed in anti-proliferative drugs during trabeculectomy.Methods With random comparison,60 cases（97 eyes） with primary glaucoma,enrolled from October 2006 to May 2007 in our hospital,were divided into amniotic membrane group（group A;20 cases,28 eyes）,amniotic membrane immersed in anti-proliferative drug（group B;24 cases,35 eyes） and mitomycin C group（group C;20 cases,34 eyes）.Patients were treated with trabeculectomy combined with biological membrane implantation under sclera flap in group A,with trabeculectomy combined with implantation of biological amniotic membrane immersed in 5-fluorouracil under sclera flap in group B,and with clinical application of 0.4 g·L^-1 mitomycin C once under and above sclera flap during trabeculectomy in group C.All patients were followed up for 12 months.The clinical efficacies of three kind surgeries were compared.Results The postoperative intraocular pressure of three groups were significantly lower than those preoperatively at 12 months after following up（all P〈0.05）.Patients whose intraocular pressure controlled be and less than 21 mmHg（1 kPa=7.5 mmHg） were 67.9% in group A,85.7% in group B and 73.5% in group C at 12 months after following up.There was significant difference for group B compared with group A or group C,also between group A and group C（all P〈0.01）.At postoperative 1 week,patients whose visual acuity remained or improved were 61.8% in group C（improved averagely in 1.1 lines）,89.3% in group A（improved averagely in 1.5 lines） and 88.6% in group B（improved averagely in 1.6 lines）.Ultrasonic biological microscope showed that lacunar of filter pillow in patients of group B was maintained more significant than that of group A or group C,and functional filtering blebs could be kept for a longer time in group B.Postoperative corneal endothelial cells counting in group C was obviously lower than that of group A or group B （both P〈0.05）.Concl

关 键 词：青光眼 小梁切除术 生物羊膜 抗增殖药物 5-氟尿嘧啶 

分 类 号：R779.6[医药卫生—眼科]