摘要
目的探讨不同球结膜筋膜瓣缝合方式对青光眼小梁切除术后滤泡弥散程度的影响。方法治疗组：女59眼,男41眼,平均57岁。其中急性闭角型青光眼缓解期58眼,慢性闭角型青光眼8眼,原发开角型青光眼34眼。对照组：女58眼,男42眼,平均59岁。其中急性闭角型青光眼缓解期56眼,慢性闭角型青光眼9眼,原发开角型青光眼35眼。采用日产TOPCON裂隙灯观察不同球结膜筋膜瓣缝合方式青光眼小梁切除手术患者术后1个月、6个月、12个月、18个月、24个月时的滤泡弥散程度,探讨缝合方式与滤泡弥散程度的关系。手术方法（术前准备和小梁切除部分省略）：做切口时用2%利多卡因紧贴结膜下浸润麻醉,角膜缘上7.5 mm剪开球结膜,向角膜缘方向钝性分离约2 mm,剪开筋膜,勿损伤上直肌鞘膜,缝合时先行将筋膜瓣用8/0可吸收缝线对位连续缝合,后将结膜瓣用8/0可吸收缝线连续缝合,达到筋膜瓣和结膜瓣错层缝合。结果两组术后1～6个月均有良好滤过泡,两组间差异无统计学意义（P〉0.05）。术后12个月、18个月、24个月在滤泡弥散程度两组间差异有统计学意义,并且随时间延长显著性增大（P〈0.05）。结论治疗组（球结膜筋膜瓣错层缝合）能有效防止滤泡的局限,可明显增加患者的舒适度,有利于眼压的远期控制。
Objective To explore the effect of two ways of suturing the bulbar conjunctiva and facial（sub-Tenon） flap on filter degree of the bleb in trabeculectomy for glaucoma. Methods 59 eyes in females and 41 eyes in males, with a mean age of 57 years were enrolled in the treatment group. Of them, 58 eyes were acute angle-closure glaucoma in an alleviated period,8 eyes were chronic angle-closure glaucoma and 34 eyes were primary angle-closure glaucoma. 58 eyes in females and 42 eyes in males, with a mean age of 59 years were enrolled in the control group. Of them, 56 eyes were acute angle-closure glaucoma in an alleviated period, 9 eyes were chronic angle-closure glaucoma and 35 eyes were primary angle-closure glaucoma. Filter degree of the follicle of the two ways was recorded at the 1st, 6th, 12th, 18th and 24th month after trabeculectomy using TOPCON slit lamp and the relation between way of suturing and filter degree of the follicle were analyzed. During the operations, 2% lidocaine was used for infiltration anesthetization, the bulbar conjunctiva was cut 7.5 mm above the limbus comeae and bluntly separated 2 mm toward the limbus comeae, and the fascial flap was cut. Then the facial flap was continuously sutured with an 8/0 absorbable suture, and the conjunctival flap with an 8/0 absorbable suture. Results The Bleb of the two groups were all well filtered in a 1- 6 month period after trabeculectomy and differences between the two groups were not significant（ P 〉 0.05）, but differences in filter degree of the bleb in the two groups were significantly different（ P 〈 0.05） on the 12th, 18th, and 24th month after trabeculectomy, and differences extended with time. Conclusion Cross-bedded suturing of the bulbar conjunctiva and fascial flap can effectively prevent localization of the follicle and is good for long-term control of intraocular pressure.
出处
《山东大学耳鼻喉眼学报》
CAS
2009年第2期94-96,共3页
Journal of Otolaryngology and Ophthalmology of Shandong University
关键词
青光眼
小梁切除术
滤泡
弥散程度
Glaucoma
Trabeculectomy
Follicular
Dispersion degree
