小梁切除术中滤过量的判断与调整

Judgment and adjustment of overfiltration in trabeculectomy

目的探讨在小梁切除术中如何准确判断滤过量并做调整，以建造适度的滤过量。方法根据人院顺序随机抽取2009年1月至2012年12月兰州市第一人民医院收治的256只眼原发性青光眼病例，在小梁切除术中重建前房时，经角膜穿刺切口向前房匀速缓慢注水同时观察前房起伏及维持状况，根据判断结果对滤过做出相应调整。另抽取同期收治的187只眼原发性青光眼小梁切除术后病例作为对比进行临床对照研究，从早期并发症的发生及3个月后有效滤过的维持做比对。结果观察组滤过不足的发生率低于对照组差异有统计学意义（Х^2=20．9，P〈0．01），浅前房的发生率高于对照组差异有统计学意义（Х^2=8．94，P〈0．01），Ⅲ度浅前房发生率低于对照组；3个月后有效滤过的维持观察组优于对照组，差异有统计学意义（Х^2=6．03，P〈0．05）。结论小梁切除术中通过前房起伏变化判断滤过量的可靠性较常规方法具有明显的优势。

Objective To discuss how to judge overfiltration correctly and adjust it in trabeculectomy, creating the right amount of overfiltration. Methods According to the order of being admitted to hospital, 256 cases of primary glaucoma were drawn at random, which were received and cured in First People＇s Hospital in Lanzhou from January 2009 to December 2012. When creating the anterior chamber in trabeculectomy, the doctor can puncture through cornea and make an incision and inject water to the anterior chamber constantly and slowly, meanwhile, observed the fluctuation of the anterior chamber, and made a corresponding adjustment to the filtration according to the result of judgment. Besides, 187 cases of primary glaucoma after the trabeculectomy received and cured during the same period were extracted and controlled clinical trial, as a contrast, were conducted, and a comparison was made from occurrence of the early complication and the effective maintenance of filtration three months later. Results The occurrence rate of filtering problem in the observation group was lower than the control group, the occurrence rate of shallow anterior chamber was higher than the control group, the occurrence rate of Ⅲ shallow anterior chamber was lower than the control group, the maintenance of effective filtration three months later in the observation group was better than the control group. Conclusions In trabeculectomy, the reliability that overfiltration can be judged by the change of anterior chamber＇s fluctuation has obvious superiority over conven- tional methods.