两种手术治疗原发性闭角型青光眼的疗效及凝血功能变化研究

Study on the Curative Effect of two Kinds of Surgical Treatment for Primary Angle Closure Glaucoma and the Changes of Blood Coagulation Function

目的探讨两种手术对原发性闭角型青光眼患者的临床疗效及凝血功能指标的变化差异。方法选取80例(80眼)原发性闭角型青光眼患者为受试对象,随机抽样法分成A、B两组,各40例。A组予以超声乳化联合房角分离术,B组予以小梁切除术。观察对比两组患者手术前后眼压、中央前房深度(CCT)及凝血指标变化情况,记录其术后房角开放>180°比率及并发症发生率差异。结果术后,两组眼压均较术前显著降低(P<0.05),但组间对比无统计学意义(P>0.05);两组CCT检查结果则较术前显著提升(P<0.05),且A组>B组(P<0.05)。术后3个月时,两组患者除PT、TT水平较术前无明显改变(P>0.05)外,Fbg水平较术前显著降低,且A组<B组(P<0.05);aPTT水平则明显升高,且A组>B组(P<0.05)。A组术后3个月时房角开放>180°比率为97.5%,显著高于B组的72.5%(P<0.05)。两组受试者术后均无感染性眼内炎、恶性青光眼等严重并发症发生,其中A组并发轻度角膜水肿及前房炎症反应4例(10.0%),B组并发轻度角膜水肿症状6例(15.0%),保守治疗后均恢复正常,术后并发症发生率对比无统计学意义(P>0.05)。结论超声乳化联合房角分离术相较于小梁切除术对原发性闭角型青光眼患者视功能和眼压的改善效果更优,手术安全理想,于患者预后恢复有利。

Objective To investigate the clinical effect of two kinds of operation on primary angle closure glaucoma patients and the changes of blood coagulation function indexes. Methods 80 cases （80 eyes） with primary angle closure glaucoma were selected as subjects. They were divided into two groups A and B based on random sampling method, each of 40 cases. Group A were treated by phacoemulsification combined with goniosychialysis, while group B were treated by trabeculectomy. The changes of intraocular pressure, central anterior chamber depth（CCT） and blood coagulation indexes were observed and compared between the two groups before and after operation, and the difference of incidence rate of chamber angle 〉 180 degrees and complication rate were recorded after operation. Results After operation, the intraoeular pressure of two groups were significantly decreased （ P 〈 0.05 ） , but there was no significant difference between the two groups（P 〉0. 05）;CCT examination results in the two groups were significantly improved（ P 〈 0. 05 ）, and group A 〉 Group B （ P 〈 0. 05 ）. 3 months after the operation, in addition to PT, TI＇ levels （ P 〉 0. 05 ）, the two groups of patients＇ level of Fbg was significantly decreased than that before surgery, and the group A 〈 group B （ P 〈 0. 05 ] ; aPTT levels were significantly elevated, and the group A 〉 group B [ （ 28.9 ± l. 5 ） sVS （ 28.0 ±1.1）s,P 〈 0. 05 ）. 3 months after the operation, the incidence rate of chamber angle 〉 180 degrees was 97.5% in group A,which was significantly higher than that in group B （72.5%） （P 〈 0.05 ）. There were no serious complications of infective endophthalmitis, malignant glaucoma occurred in the two groups of patients, wherein complicated with mild corneal edema and anterior chamber inflammation 4 cases （ 10. 0% ） in the group A,complicated with mild corneal edema 6 cases（ 15.0% ）in the group B, after conservative treatment,all patients returned to normal, and there was no significant difference in the incidence of postoperative complications（P 〉 0.05 ）. Conclusion Compared with trabeculectomy, phacoemulsification combined with goniosychialysis can improve visual function and intraocular pressure in patients with primary angle closure glaucoma better. And the Surgery is safe and ideal. It is also favorable to the recovery of patients＇ prognosis.