球筋膜下麻醉的复合式小梁切除术治疗青光眼临床观察

Combined trabeculectomy to treat glaucoma under sub-Tenon' s anesthesia

目的探讨球筋膜下麻醉进行复合式小梁切除术治疗青光眼临床效果。方法我院连续收入院的128例青光眼患者分为观察组和对照组。观察组65例:球筋膜下麻醉进行以角膜缘为基底的结膜瓣的复合式小梁切除术治疗青光眼;对照组68例:球后麻醉进行以穹窿部为基底的结膜瓣的复合式小梁切除术治疗青光眼,观察患者合作度,眼压、滤过泡形态。结果球筋膜下麻醉组有89.2%的患者术中合作较好,球后麻醉组有88.2%的患者合作比较好或非常好,两组比较差异无统计学意义(P>0.05)。两组术前眼压相似,差异无统计学意义(P>0.05),术后6月眼压:观察组11.42±5.16mmHg,对照组14.12±3.24mmHg,差异有统计学意义(P<0.05)。眼压≤21mmHg为标准,观察组的完全成功率为92.3%。对照组完全成功率为80.9%,两组比较差异有统计学意义(P<0.05)。滤过泡的形态:观察组以弥散型为主,对照组以微小囊泡型为主,两组比较差异有统计学意义(P<0.05)。结论球筋膜下麻醉手术进行中能获得满意的合作度两种类型的结膜瓣形态及降压效果不同。

Objetive To investigate the clinical effect of combined trabecnletomy to treat glaucoma under sub-Tenon＇s anesthesia.Methods 133 consecutive patients with glaucoma surgery received sub-Tenon＇s anesthesia and limbus-based conjunctiva flap（observe group of 65 cases ） or retrobulbar anesthesiax and fornix- based conjunctiva flap（control group of 68 cases ） in the surgery.The patients were asked to grade their cooperation.And the intraocular pressure and morphology ol bleb were recorded.Results Intraocular pressure before treatment in both groups was similar（P0.05）.Mean IOP of 6 months after treatment was 14.12±3.24mmHg in limbus-based conjunctiva flap and 11.42±5.16mmHg in Fornix-based conjunctiva flap,and there was significant difference（P0.05）。The success rate（IOP lower than 21mmHg ） was 92.3%in eyes with limbus-based conjunctiva flap versus 80.9%in eyes with Fornix-based conjunctiva flap,and there was not significant difference（P0.05 ）。Morphology of Fornix-based conjunctiva flap tends to have more diffused,while bleb of Limbus-based conjunctiva flap tends to have microcyst Conclusion sub-Tenon＇s anesthesia could provide satisfied cooperation,so it was a safe and effective anesthesia method for glaucoma surgery.The morphology of two types of conjunctiva flap seems different and the success rate was different between the two types of flap.