可调整缝线联合丝裂霉素C在小梁切除术中的应用

Application of MMC and adjustable suture line on the trabeculectomy

目的:分析可调整缝线及丝裂霉素C在小梁切除术中的应用及手术后的效果。方法:对65例65眼各种类型青光眼患者行小梁切除术,术中一次性应用丝裂霉素C联合巩膜瓣可调整缝线,术后随访3mo～1a,观察手术前后的眼压、术后切口对合、前房形成、滤过泡形态及并发症的情况。结果:术后第1d前房形成63眼(96.9%),浅Ⅰ级前房1眼(1.5%),浅Ⅱ级前房1眼(1.5%);术后7～10d出院时眼压平均为13.6mmHg,6mo眼压平均为14.9mmHg,1a眼压平均为16.7mmHg。所有病例术前术后视力不变或略有提高;出院时均有弥散滤过泡形成。可调线依据眼压、前房、滤过情况于术后1～2wk时酌情拆除,必要时辅以眼球按摩辅助滤过形成,眼压可以下降2～8mmHg。结论:可调整缝线、丝裂霉素C联合小梁切除术治疗青光眼安全性高,术后并发症少,疗效确切,操作简便,适合于基层医院开展。

AIM： To analyze the effects of application of mitomycin C（MMC） and adjustable suture line on the trabeculectomy. METHODS： Analysis of 65 eyes of 65 glaucoma cases was conducted. MMC and adjustable suture line were used in the trabeculectomy. The patients were visited for 3 months to 1 year and the eye pressure before and after operation, incisal opening anastomosis, anterior chamber formation, filtering bleb and complication after operation were observed. RESULTS：Anterior chamber formed in 63 eye （96.9%） one day after operation, with grade Ⅰ shallow anterior chamber in 1 eye （1. 5%）, grade Ⅱ shallow anterior chamber in eye （1.5%）. During the 7^th day to 10^th day after operation, the average eye pressure was 13.6mmHg, 14.9mmHg after 6 months and 16.7mmHg after one year. All the eyesight of the patients kept unchanged before and after the operation or improved slightly, and the filtering bleb formed. The adjustable suture line could .be taken out of the wound according to the eye pressure, anterior chamber and its filtering within one to two weeks after operation. It is necessary to massage the eye balls to help to form the filtering. In this case the eye pressure could be dropped to 2-8mmHg. CONCLUSION： The adjustable suture line and MMC on trabeculectomy could be safely applied and the complication obviously is decreased. It can be applied in the grass-roots level hospitals because of its remarkable curative effect and simple operation.