小梁切除术后应用激光断线术的临床疗效及安全性评价  

Controlled clinical study of laser scleral disconnection after trabeculectomy and scleral lateral adjustment suture in trabeculectomy

作　　者：杨桂萍[1] 冯俊[1] 王民秀[1] 杨永升[1] 陈杰[1] 李欣[1] 张燕[1] YANG Guiping;FENG Jun;WANG Minxiu(Eye Hospital,China Academy of Chinese Medical Sciences,Beijing 100040,China)

机构地区：[1]中国中医科学院眼科医院,北京100040

出　　处：《中国中医眼科杂志》2021年第6期411-415,共5页China Journal of Chinese Ophthalmology

基　　金：中国中医科学院眼科医院院内课题(201619)。

摘　　要：目的探讨小梁切除术后应用激光巩膜断线术的安全性及可行性。方法纳入2016年2月—2019年2月行小梁切除手术的各类青光眼患者86例。随机分为A组:激光断线28例(30只眼);B组:调整缝线28例(30只眼);C组:常规小梁切除术30例(30只眼),分析比较3组病例患者的术后视力、眼压、滤过泡形态、视盘神经纤维层(RNFL)厚度,随访6个月。结果(1)视力:术后6个月与术前比较,3组患者视力差异均有统计学意义(t_(A组)=3.404,P=0.002,t_(B组)=4.129,P=0.000,t_(C组)=4.167,P=0.000)。(2)眼压:术后6个月3组患者眼压较术前降低,差异均有统计学意义(t_(A组)=24.196,t_(B组)=22.661,t_(C组)=22.420,均P=0.000)。治疗后3组组间比较,差异无统计学意义(P>0.05)。(3)视野及RNFL厚度:术后6个月3组患者视野及RNFL厚度值较术前无明显变化,差异无统计学意义;治疗后3组组间比较,差异无统计学意义(P>0.05)。(4)术后并发症:A组术后并发症发生率为13.33%,B组为16.67%,C组为33.33%。3组术后组间比较,差异无统计学意义(P>0.05)。(5)术后磨痛症状:A组术后磨痛症状发生率为6.67%;B组为70.00%;C组为10.00%。3组术后组间比较,差异有统计学意义(χ^(2)=37.103,P=0.000),A组与B组组间比较(χ^(2)=24.452,P=0.000),B组与C组组间比较(χ^(2)=22.500,P=0.000),差异具有统计学意义。A组与C组组间比较,差异无统计学意义(P>0.05)。结论在小梁切除术后应用激光断线术与巩膜瓣两侧调整缝线均可以通过定量控制滤过,减少浅前房的发生。而激光断线技术在缩短手术时间、操作简单、术后并发症少等方面更具优势。OBJECTIVE To investigate the safety and feasibility of laser scleral suture breaking after trabeculectomy.METHODS 86 glaucoma patients who underwent trabeculectomy from February 2016 to February 2019 were included.They were randomly divided into group A:28 cases of laser suture breaking(30 eyes),group B:28 cases of scleral lateral adjustment suture(30 eyes),and group C:30 cases of conventional trabeculectomy(30 eyes).The postoperative visual acuity,intraocular pressure,filtering bleb shape and RNFL thickness of the three groups were analyzed and compared.The patients were followed up for 6 months.RESULTS(1)visual acuity:six months after operation,there were statistically significant differences in visual acuity among the three groups(t_(AG)=3.404,P=0.002,t_(BG)=4.129,P=0.000,t_(CG)=4.167,P=0.000).(2)Intraocular pressure:6 months after operation,the intraocular pressure of the three groups was lower than that before operation,and the differences were statistically significant(t_(AG)=24.196,t_(BG)=22.661,t_(CG)=22.420,all P=0.000).There was no significant difference among the three groups after treatment(P>0.05).(3)visual field and RNFL thickness:The visual field and RNFL thickness value of patients in the 6 months after surgery did not change significantly compared to preoperative,and the different was not statistically significant.Comparing the three groups after treatment,the different was not statistically significant.(4)Early and late postoperative complications:the incidence of postoperative complications was 13.33% in group A,16.67% in group B and 33.33% in group C.There was no significant difference among the three groups(P>0.05).(5)Postoperative grinding pain:the incidence of postoperative grinding pain in group A was 6.67%;In group B,the incidence was 70.00%;The incidence rate of group C was 10.00%.Compared with group B,group A and group C have statistical differences(X_(2 AG)=24.452,X_(2 CG)=22.500,all P=0.000).There is no statistical differences between group A and group C(P>0.05).CONCLUSIONS In trabecu

关 键 词：青光眼 激光断线 调整缝线 

分 类 号：R755[医药卫生—皮肤病学与性病学]