本文選題：準分子激光上皮瓣下角膜磨鑲術(shù) + 絲裂霉素C��； 參考：《寧夏醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：研究準分子激光上皮瓣下角膜磨鑲術(shù)（LASEK）中使用絲裂霉素C（MMC）對角膜內(nèi)皮細胞的影響及其與殘余角膜基質(zhì)厚度、MMC作用時間的關(guān)系，并分析該手術(shù)中MMC使用的安全性問題。 方法：選擇行LASEK手術(shù)的病例49例（98只眼），術(shù)中激光切削后，使用0.02%絲裂霉素C吸血海綿片覆蓋于殘余角膜基質(zhì)床上，根據(jù)預(yù)矯屈光度數(shù)調(diào)整MMC的使用時間。分組方式一，根據(jù)預(yù)矯屈光度數(shù)計算殘余角膜基質(zhì)厚度（d），分為A、B、C三組，其中A組：300μm≤d320μm，共11只眼；B組：320μm≤d340μm，共10只眼；C組：d≥340μm，共77只眼；分組方式二：按照術(shù)中MMC與角膜基質(zhì)接觸的時間（t），分為T1、T2兩組，其中T1組：15s≤t≤45s，，共65只眼；T2組：45st≤70s，共33只眼。分別于術(shù)前,術(shù)后1周、1月、3月、6月時，采用非接觸式角膜內(nèi)皮細胞計測定角膜中央點、周邊四點的角膜內(nèi)皮細胞密度、六邊形細胞百分比、變異系數(shù)、平均細胞面積、面積標準差、最大細胞面積、最小細胞面積，并利用SPSS軟件統(tǒng)計數(shù)據(jù)，分析角膜內(nèi)皮細胞各個參數(shù)的變化情況。 結(jié)果：1.不同殘余角膜基質(zhì)厚度組間、不同MMC作用時間組間中央、周邊角膜內(nèi)皮細胞密度、變異系數(shù)、面積標準差、六邊形細胞百分比、平均細胞面積、最大細胞面積、最小細胞面積分別互相比較時，均無顯著性差異（P0.05）；每組在相同時期中央與周邊角膜內(nèi)皮細胞相同參數(shù)比較差異均無統(tǒng)計學(xué)意義（P0.05）。 2.按殘余角膜基質(zhì)厚度分組時：A、B、C三組術(shù)后不同時期，中央、周邊角膜內(nèi)皮細胞參數(shù)與術(shù)前相比： 1)角膜內(nèi)皮細胞密度、面積標準差、最大細胞面積、最小細胞面積均與術(shù)前相比無顯著性差異（P0.05）； 2) B組術(shù)后1月時中央角膜內(nèi)皮細胞變異系數(shù)與術(shù)前相比差異有統(tǒng)計學(xué)意義（P0.05），術(shù)后1月明顯大于術(shù)前，其余與術(shù)前相比無顯著性差異（P0.05）； 3) A、B、C三組術(shù)后1周時中央角膜內(nèi)皮細胞六邊形細胞百分比與術(shù)前相比差異均有統(tǒng)計學(xué)意義（P0.05），術(shù)后1周明顯小于術(shù)前，其余與術(shù)前相比無顯著性差異（P0.05）； 4) B、C組術(shù)后1周時周邊角膜內(nèi)皮細胞平均面積與術(shù)前相比差異均有統(tǒng)計學(xué)意義（P0.05），術(shù)后1周明顯大于術(shù)前，其余與術(shù)前相比無顯著性差異（P0.05）。 3.按MMC不同作用時間分組：T1、T2兩組術(shù)后不同時期，中央、周邊角膜內(nèi)皮細胞參數(shù)與術(shù)前相比： 1)角膜內(nèi)皮細胞密度，面積標準差，最大、最小細胞面積與術(shù)前相比均無顯著性差異（P0.05）； 2) T1、T2組術(shù)后1周時中央角膜內(nèi)皮細胞變異系數(shù)與術(shù)前相比差異均有統(tǒng)計學(xué)意義（P0.05），術(shù)后1周大于術(shù)前，其余與術(shù)前相比無顯著性差異（P0.05）； 3) T1、T2組術(shù)后1周時中央角膜內(nèi)皮六邊形細胞百分比與術(shù)前比差異均有統(tǒng)計學(xué)意義（P0.05），術(shù)后1周小于術(shù)前，其余與術(shù)前相比無顯著性差異（P0.05）； 4) T1、T2組術(shù)后1周時周邊角膜內(nèi)皮細胞平均面積與術(shù)前相比差異均有統(tǒng)計學(xué)意義（P0.05），術(shù)后1周大于術(shù)前，其余與術(shù)前相比無顯著性差異（P0.05）。結(jié)論:1.LASEK術(shù)中一次性使用MMC，在合理的濃度和時間范圍內(nèi)，不會引起角膜內(nèi)皮細胞密度變化；術(shù)后短期內(nèi)會有中央角膜內(nèi)皮六邊形細胞百分比降低、變異系數(shù)升高、周邊角膜內(nèi)皮細胞平均面積增大，均為短暫的、一過性改變，隨著時間逐漸恢復(fù)至術(shù)前水平。 2.角膜內(nèi)皮細胞計數(shù)應(yīng)列為LASEK手術(shù)的常規(guī)檢查之一，以更加靈敏、準確的評價角膜健康狀態(tài)。
[Abstract]:Objective: To study the effect of mitomycin C (MMC) on corneal endothelial cells and the relationship with the thickness of corneal stroma and the time of MMC action in the excimer laser keratomileusis (LASEK), and to analyze the safety of MMC in the operation.
Methods: 49 cases (98 eyes) with LASEK operation were selected. After intraoperative laser cutting, 0.02% mitomycin C blood sucking sponge was used to cover the residual corneal stroma bed, and the use time of MMC was adjusted according to the pre correction diopter. The group method was divided into groups of A, B, C three according to the pre corrected diopter count (d), which were divided into groups of A, A, and C. Group: 300 mu m < D320 m, a total of 11 eyes, group B: 320 mu m < D340 mu m, a total of 10 eyes, C group: d > 340 mu m, 77 eyes, two: according to the time of contact between the MMC and the corneal stroma during the operation (t), two groups, including 65 or less than 33 eyes, respectively, before the operation, 1 weeks, January, 3, respectively. During the month and June, the corneal endothelial cell density, the percentage of hexagonal cells, the coefficient of variation, the average cell area, the area of the cell, the maximum cell area, the minimum cell area, and the variation of the parameters of the corneal endothelial cells were analyzed by the contact corneal endothelial cell meter, the corneal endothelial cell density at four peripheral points, the percentage of hexagonal cells, the average cell area, the area standard difference, the area of the cell, the minimum cell area. Change the situation.
Results: 1. there were no significant differences in the density, coefficient of variation, area standard deviation, percentage of hexagonal cells, average cell area, maximum cell area and minimum cell area (P0.05) in the central corneal endothelial cell density, coefficient of variation, area standard deviation, average cell area and minimum cell area (P0.05), each group was in the same period. Each group was in the same period (MMC). There was no significant difference in the same parameters between central and peripheral corneal endothelial cells (P0.05).
2. according to the residual corneal stroma thickness: A, B, C three groups at different times after operation, the central and peripheral corneal endothelial cell parameters were compared with those before operation.
1) corneal endothelial cell density, area standard deviation, maximum cell area and minimum cell area were not significantly different from those before operation (P0.05).
2) there was a significant difference in the coefficient of variation of the central corneal endothelium in the central corneal endothelium in the B group in January (P0.05), and the postoperative January was significantly greater than that before the operation, and there was no significant difference between the rest and the preoperative (P0.05).
3) the percentage of hexagonal cells of central corneal endothelial cells in A, B and C three groups were statistically significant (P0.05) at 1 weeks after operation (P0.05). There was no significant difference between the two groups (P0.05).
4) the average area of corneal endothelial cells in peripheral cornea was statistically significant (P0.05) at 1 weeks after operation (P0.05) at 1 weeks after operation (P0.05), and 1 weeks after operation was significantly greater than that before operation, and the rest had no significant difference compared with preoperative (P0.05).
3. according to MMC different time groups: T1, T2 two groups at different times after operation, the central and peripheral corneal endothelial cell parameters were compared with those before operation.
1) corneal endothelial cell density, area standard deviation, maximum and minimum cell area were not significantly different from those before operation (P0.05).
2) T1, in group T2, there were significant differences in the coefficient of variation of the central corneal endothelial cells at 1 weeks after operation (P0.05), and 1 weeks after the operation were greater than that before the operation, and the rest were not significantly different from that before the operation (P0.05).
3) the percentage of hexagonal cells in the central corneal endothelium was statistically significant (P0.05) at 1 weeks after operation (P0.05) at 1 weeks after operation (P0.05), and 1 weeks after operation was less than that before the operation, and the rest was not significantly different from that before operation (P0.05).
4) T1, in group T2, the average area of corneal endothelial cells in peripheral cornea was significantly different from preoperative (P0.05) at 1 weeks after operation (P0.05), and there was no significant difference between the rest and preoperative (P0.05). Conclusion: the use of MMC in 1.LASEK during a reasonable concentration and time would not cause the change of corneal endothelial cell density. In the short term, the percentage of hexagonal cells in the central corneal endothelium, the coefficient of variation and the average area of the peripheral corneal endothelial cells increased in a short time after the operation, which were both transient, and gradually recovered to the preoperative level.
2. corneal endothelial cell count should be listed as one of the routine examinations of LASEK surgery to evaluate the corneal health status more sensitively and accurately.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R779.6

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