完全可拆除调节缝线在小梁切除术中临床应用

The efficacy of complete releasable suture of scleral flap in trabeculectomy

目的 探讨完全可拆除巩膜瓣调节缝线在小梁切除术中的临床应用效果.方法 对拟行小梁切除术的青光眼63例（80眼）随机分为两组：观察组（A组）29例（40眼）行完全可拆除巩膜瓣调节缝线的小梁切除术;对照组（B组）34例（40眼）行常规小梁切除术.术后观察前房情况、滤过泡形态、眼压、视力及并发症.随访3～6个月.结果 A组：未拆除调节缝线前无浅前房发生,拆除后发生浅前房7眼（17.5％）,B组浅前房9眼（22.5％）,两组差异无统计学意义（χ2 =2.83,P＞20.05）.功能性滤过泡形成：A组33眼（82.5％）,B组28眼（70.0％）,差异具有统计学意义（χ2=7.65,P＜0.05）.眼压：术后3个月、6个月,A组眼压控制较好,两组眼压下降比较差异具有统计学意义（t=2.536,2.489,P＜0.05）.术后视力：早期A组视力恢复较好,组间差异具有统计学意义（x2=8.94,P＜0.05）.术后两组主要并发症为脉络膜脱离,B组3眼（7.5％）发生角膜缘切口漏.结论 完全可拆除巩膜瓣调节缝线应用于小梁切除术,降低了术后早期并发症,提高了中远期手术疗效.

Objective To investigate the efficacy of complete releasable suture in trabeculectomy.Methods 80 eyes of 63 cases who suffered glaucoma and planed to undergo trabeculectomy were randomly divided into two groups：29 cases （40 eyes） in trial group （Group A） received trabeculectomy using complete releasable sutures in scleral flap.And 34 cases （40 eyes） in control group （Group B） underwent conventional trabeculectomy.The anterior chamber,filtering bleb,intraocular pressure,visual acuity and complications were observed in the following 3 ～6 months after the surgery.Results The shallow anterior chamber were not observed before removing the releasable suture in Group A,but it occurred in 7 eyes （17.5%） after removing the suture in Group A and 9 eyes （22.5%） in Group B.The difference was not statistically significant （χ2 =2.83,P 〉0.05）.33 eyes （82.5%） in Group A and 28 eyes （70.0%） in Group B were observed with functional filtering bleb.And the difference was statistically significant （χ2 =7.65,P 〈 0.05）.The difference of decreasing intraocular pressure （IOP） between the two groups was statistically significant （t =2.536,2.489,P 〈 0.05） in 3 months and 6 months.And the difference of visual acuity was statistically significant （χ2 =8.94,P 〈 0.05） in early time after the surgery.The main postoperative complication was choroidal detachment.And corneal incision leakage was detected in 3 eyes （7.5%） in Group B.Conclusion It can reduce early postoperative complications and improve the longterm effects that using complete releasable suture in scleral flap in trabeculectomy.