窦小梁切除术联合丝裂霉素C与窦小梁切除联合羊膜移植术治疗青光眼的疗效分析

Trabeculectomy combined with mitomycin C and trabeculectomy combined with amniotic membrane transplantation in the treatment of the re operation of glaucoma long-term efficacy and application value of contrast

目的探讨窦小梁切除术联合丝裂酶菌素C与窦小梁切除联合羊膜移植术治疗青光眼的疗效。方法收集山东省寿光市人民医院临床医疗科2010年8月至2013年3月收治的94例(188只眼)再次手术的青光眼患者的临床资料。按照随机数字表法将患者分为A组和B组,每组各47例(94只眼)。A组患者采取窦小梁切除联合羊膜移植术进行治疗,B组患者采取窦小梁切除术联合丝裂酶菌C进行治疗,比较两组患者的临床治疗效果。两组患者术后的远期疗效按照显效、有效和无效分为3个等级,以例数和百分比的形式表示,并采用Kruskal-Wallis H秩和检验的方法进行比较。两组患者手术前及手术后3,12个月的眼压以均数±标准差(珔x±s)的形式表示,并采用两因素重复测量方差分析的方法进行组间比较,采用t检验的方法进行组内比较。两组患者术后并发症的发生情况采用卡方检验进行比较。结果 A组显效者32例(64只眼),显效率为68.09%;有效者11例(22只眼),有效率为48.94%;无效者4例(4只眼),无效率为8.51%。B组显效者23例(23只眼),显效率为48.94%;有效者12例(12只眼),有效率为25.53%;无效者12例(12只眼),无效率为25.53%。两组患者临床远期疗效比较,差异有统计学意义(Hc=-2.31,P<0.05)。手术前A组患者的眼压为(37.98±5.24)mmHg,术后3个月的眼压为(15.24±4.12)mmHg,术后12个月的眼压为(13.41±3.65)mmHg,A组患者术前与术后3,12个月的眼压比较,差异有统计学意义(t=23.38,26.38;P<0.05)。手术前B组患者的眼压为(38.42±5.47)mmHg,术后3个月的眼压为(18.97±4.56)mmHg,术后12个月的眼压为(16.47±3.78)mmHg,B组患者术前与术后3,12个月的眼压比较,差异有统计学意义(t=18.72,22.63;P<0.05)。术后A组患者的眼压低于B组,差异有统计学意义(F=6.20,P<0.05)。A组发生并发症3例(3只眼),占6.38%;其中浅前房2例(2只眼),占4.26%;前葡萄膜炎1例(1只眼),占2.13%。B组发生并发症10例(10只眼),占21.28%;其中浅前房3例(3只眼),占6.38%;前葡萄膜炎4例(4只眼),占8.51%;眼部感染3例(3只眼),占6.38%。A组患者并发症的发生率明显低于B组,差异有统计学意义(χ2=14.96,P<0.05)。结论窦小梁切除联合羊膜移植术治疗青光眼的远期疗效优于窦小梁切除术联合丝裂霉素C,眼压控制情况良好,具有更高的应用价值。

Objective To investigate the trabeculectomy with mitomycin C combined with streptozotocin and trabeculectomy combined with amniotic membrane transplantation for treatment of glaucoma clinical analysis of reoperation.Methods Hospital from August 2010 to March 2013 were treated94cases of reoperation for glaucoma patients for the study,47 cases were randomly divided into group A,take trabeculectomy with amniotic membrane transplantation therapy,group B 47 cases,implementation of trabeculectomy with mitomycin C treatment bacteria,two groups of patients for clinical effectiveness analysis.Results A group after treatment,32 cases,accounting for 68.09%,effective in 11 cases,accounting for23.40%,4cases,accounting for 8.51%,the total effective rate was 91.49%,after the group B patients showed 23 cases,accounting for 48.94%,effective 12 cases,accounting for 25.53%,12 cases,accounting for25.53%,the total effective rate was 74.47%,there is a significant difference（χ2=5.7542,P〈0.05）;mean preoperative IOP A group（37.98 ± 5.24）,Group B mean IOP（38.42 ± 5.47）,no significant difference in the two groups（t=1.0241,P〈0.05）;after 3months,A group mean IOP（15.24± 4.12）,the mean IOP in group B（18.97±4.56）.A group was significantly lower than group B,the difference was statistically significant（t=5.2154,P〈0.05）,after 12 months,A group mean IOP（13.41 ± 3.65）,the mean IOP in group B（16.47±3.78）.A group was significantly lower than group B,the difference was statistically significant（t=6.3527,P〈0.05）.A group of shallow anterior chamber two cases,accounting for 4.26%,uveal inflammation occurred before 1case,accounting for 2.13%,infection did not occur,the complication rate was 6.38%,group B shallow anterior chamber three cases,accounting for 6.38%,uveal inflammation occurred before 4cases,accounting for 8.51%,three cases of infection occur,accounting 6.38%,the complication rate was 21.28%,A group complication rate was significantly lower than group B,the difference was statistically significant（χ2= 5.3254,P〈0.05）.Conclusion Trabeculectomy with mitomycin cephalosporin C,amniotic membrane transplantation were on combination therapy were re-glare eye surgery patients have a good therapeutic effect,but better trabeculectomy with amniotic membrane transplantation combined treatment of long-term efficacy lowering intraocular pressure,and has a higher value.