小梁切除联合生物羊膜移植术在青光眼滤过性手术中的应用研究  

Clinical observation of trabeculectomy combined with amniotic membrane transplantation in glaucoma filtering surgery

作　　者：唐建明 陆豪 忽俊 朱蓓菁 熊毅 钱锦 Tang Jianming Lu Hao Hu Jun Zhu Beifing Xiong Yi Qian fin.(Department of Ophthalmology, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201900, China)

机构地区：[1]上海市宝山区中西医结合医院眼科,201900

出　　处：《中华眼科医学杂志（电子版）》2017年第4期171-176,共6页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：上海市卫生局青年课题基金(20124Y026)

摘　　要：目的观察生物羊膜移植在青光眼滤过性手术中的临床疗效。方法选取2011年3月至2015年3月于上海市宝山区中西医结合医院眼科诊断为闭角型青光眼并进行手术的患者78例(92只眼)的临床资料。将全部患者按照数字表法随机分为3组。其中,单纯行小梁切除术的患者为小梁切除组,行小梁切除联合生物羊膜移植术的患者分为羊膜1组和羊膜2组。羊膜1组羊膜的植入位置为巩膜瓣下,羊膜2组羊膜的植入位置为结膜下。所有手术均由同一位医师完成。术前与术后视力的比较采用秩和检验。三组患者不同时间点眼压的比较采用两因素重复测量方差分析。三组患者术后6个月时滤过泡长径与宽径的比较采用方差分析,当差异有统计学意义时,进一步两两比较。三组患者手术成功率的比较采用χ~2检验。结果三组患者手术前后的最佳矫正视力均显著提高,差异有统计学意义(u=-4.99,P<0.05)。对三组患者术前与术后1周、1个月、3个月及6个月的眼压进行随访,不同时间点的比较差异有统计学意义(F_(时间)=15.67,P<0.05),但三组组间的比较差异无统计学意义(F_(组间)=1.28,P>0.05)。羊膜2组术后局部滤过泡充血的时间较另两组长,且滤过泡相对扁平。将三组患眼的滤过泡长径与宽径进行比较,差异有统计学意义(F=104.66,20.40;P<0.05),进一步两两比较,小梁切除组与羊膜2组滤过泡长径与宽径的差异有统计学的意义(t=10.55,8.97;P<0.05)。小梁切除组与羊膜2组各出现2例前房Ⅰ度并发症,经过散瞳处理后,恢复状况良好。三组患者均未出现恶性青光眼及脉络膜脱离等严重并发症。小梁切除术的手术成功率为81.81%,羊膜1组的手术成功率为91.67%,羊膜2组的手术成功率为88.24%。三组手术成功率的比较差异无统计学意义(χ~2=1.26,P>0.05)。结论小梁切除联合生物羊膜移植术治疗闭角型青光眼的疗效显著,手术成功率�Objective To observe the application of biological amniotic membrane in glaucoma filtration surgery. Methods Choose from March 2011 to March 2015,78 patients（ 92 eyes） of angle closure glaucoma were treated in Shanghai Baoshan District traditional Chinese and Western medicine hospital,performed a retrospective analysis. All patients were randomly divided into 3 groups,underwent trabeculectomy in patients of 1 group, underwent trabeculectomy combined with amniotic membrane transplantation in patients of 2 groups,including group one of patients placed in the amniotic membrane under the scleral flap,group two were placed in the amniotic membrane under conjunctiva. All the operations were performed by the author, visual acuity, intraocular pressure, follicles, anterior chamber and complications were observed every day for one week after operation. After operation 6 months,the long diameter,and width diameter of the filtration bubble were measured by UBM. To compare the clinical effects of three surgical procedures. Results The best corrected visual acuity of the three groups before and after the operation was improved significantly,the difference was statistically significant（ u =-4. 99,P 0. 05）.Three groups of patients before and after 1 week,1 month,3 months and 6 months follow-up of intraocular pressure,there was significant difference between different time points（ F = 15.67,P0.05）,but there was no statistically significant differences between the three groups,（ F_（group）= 1.28,P0.05）.In the 2 groups,the time of local filtration and vesicle congestion was higher than that of the other two groups,and the filtering blebs were relatively flat. Three eyes with bleb length and width were compared, the difference was statistically significant（ F = 104. 66,20. 40; P 0. 05） further comparison of trabeculectomy with amniotic membrane group 2 group bleb,the difference was statistically significant（ t = 10.55,8.97; P0.05）. There were 2 cases of anterior chamber Ⅰ degree complications in the 2 g

关 键 词：青光眼 小梁切除术 生物羊膜移植 

分 类 号：R779.6[医药卫生—眼科]