發(fā)布時間：2018-05-19 20:25

  本文選題：青光眼引流物 + 小梁切除術(shù)��； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的通過檢索文獻(xiàn)及系統(tǒng)評價的方法探討不同手術(shù)應(yīng)用于青光眼的療效差異,為臨床治療青光眼的方式選擇提供依據(jù)。方法選用“小梁切除術(shù)”、“青光眼閥”、“青光眼引流器”為中文檢索詞,檢索中國知網(wǎng)、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、和萬方數(shù)據(jù)庫中公開發(fā)表的中文文獻(xiàn),選用“glaucoma drainage implant”,“trabeculectomy”,“glaucoma filtration implant”,“aqueous shunt”為英文檢索詞,檢索Pubmed,Web of science,EMBASE,Cochrane Library數(shù)據(jù)庫中公開發(fā)表的英文文獻(xiàn),檢索年限為1983年至2015年。Endnote軟件和手工剔除重復(fù)文獻(xiàn),兩位研究員按照納入、排除的標(biāo)準(zhǔn)篩選文獻(xiàn),質(zhì)量評價。按納入排除標(biāo)準(zhǔn)最終篩選出相關(guān)文獻(xiàn)4篇。按文獻(xiàn)選入?yún)?shù):眼壓下降百分率(IOPR%);手術(shù)后1年時未使用降眼壓藥物達(dá)到目標(biāo)眼壓的成功率、手術(shù)后1年時使用降眼壓藥物達(dá)到目標(biāo)眼壓的成功率;術(shù)后淺前房發(fā)生率、術(shù)后前房積血發(fā)生率、術(shù)后切口滲漏發(fā)生率。文獻(xiàn)中113例接受EX-PRESS青光眼引流器植入術(shù),59例接受Ahmed青光眼閥植入術(shù),作為此次研究的干預(yù)組(GDD組);179例接受青光眼小梁切除術(shù)作為對照組(Tra組)。用Rev Man5.2軟件對納入的文獻(xiàn)進(jìn)行meta分析。結(jié)果控制眼壓,兩組的眼壓下降百分率(IOPR%)無明顯統(tǒng)計學(xué)差異,(MD=-0.59;95%CI,-7.48-6.29;P=0.87),兩組手術(shù)降低眼壓效果相似;手術(shù)后1年患者未使用抗青光眼藥物達(dá)到目標(biāo)眼壓(5IOP18mm Hg)的手術(shù)成功率,GDD組優(yōu)于Tra組,結(jié)果有明顯統(tǒng)計學(xué)差異(OR=5.80;95%CI,2.14-15.71,P=0.0006);手術(shù)后1年患者使用抗青光眼藥物達(dá)到目標(biāo)眼壓(5IOP18mm Hg)的手術(shù)成功率,GDD組優(yōu)于Tra組,具有統(tǒng)計學(xué)差異(OR=2.51;95%CI,1.25-5.05;P=0.010);手術(shù)后淺前房發(fā)生率,兩組無明顯統(tǒng)計學(xué)差異(OR=0.95;95%CI,0.52-1.75,P=0.87);手術(shù)后前房積血發(fā)生率,兩組無明顯統(tǒng)計學(xué)差異(OR=0.52;95%CI,0.22-1.22,P=0.13);手術(shù)后傷口滲漏發(fā)生率,兩組無明顯統(tǒng)計學(xué)差異(OR=0.59;95%CI,0.20-1.75,P=0.34),GDD組未使手術(shù)后并發(fā)癥的發(fā)生率增加。結(jié)論青光眼引流物植入術(shù)與小梁切除術(shù)控制眼壓效果及安全性相仿;青光眼引流物植入術(shù)能顯著提高手術(shù)成功率,對臨床治療青光眼具有一定的指導(dǎo)意義。
[Abstract]:Objective to explore the difference of the curative effect of different operation in glaucoma by searching the literature and evaluating systematically, so as to provide the basis for the choice of clinical treatment of glaucoma. Methods "trabeculectomy", "glaucoma valve" and "glaucoma draining device" were selected as Chinese key words. "glaucoma drainage implant", "trabeculectomy", "glaucoma filtration implant" and "aqueous shunt" were selected as the key words to search the published English articles published in the Pubmedan Web of Science EMBASE Cochrane Library database. The search period was from 1983 to 2015. The two researchers screened the literature and evaluated the quality according to the inclusion and exclusion criteria. Finally, 4 articles were selected according to the exclusion criteria. According to the selected parameters of the literature: IOP drop percentage was lower than IOP; the success rate of IOP was achieved 1 year after operation without the use of IOP lowering drugs, the success rate of IOP was achieved by using IOP drug at 1 year after operation, the incidence of shallow anterior chamber after operation was lower than that of IOP group. The incidence of postoperative hyphema and postoperative incision leakage. In the literature, 59 cases received EX-PRESS glaucoma valve implantation and 59 cases received EX-PRESS glaucoma drainage device implantation. In this study, 179 cases received trabeculectomy of glaucoma trabeculectomy as control group. Rev Man5.2 software was used to analyze the included literature by meta. Results there was no significant difference in the percentage of IOP decrease between the two groups (MD-0.59 ~ 95CI-7.48-6.29). The effect of IOP reduction in the two groups was similar, and the success rate of the GDD group was better than that of the Tra group one year after operation without using anti-glaucoma drugs to reach the target IOP (18 mm Hg.). Results there was significant statistical difference between the two groups (2.14-15.71) and the successful rate of operation in GDD group was better than that in Tra group (P 0.010), and the incidence of superficial anterior chamber was higher in GDD group than in Tra group, and the incidence of superficial anterior chamber was significantly higher in GDD group than in Tra group (P < 0.05), and the incidence of superficial anterior chamber was significantly higher in GDD group than in Tra group (P < 0.05). There was no significant statistical difference between the two groups. There was no significant difference between the two groups in the incidence of anterior chamber hemorrhage after operation. There was no significant difference between the two groups in the incidence of anterior chamber hemorrhage. There was no significant difference between the two groups in the incidence of wound leakage after operation. There was no significant difference between the two groups in the incidence of postoperative complications in the GDD group (OR0.5995CI0.20-1.75) and the incidence of postoperative complications was not increased in the GDD group. Conclusion Glaucomatous drainage implantation is similar to trabeculectomy in the control of intraocular pressure, and glaucoma drainage implantation can significantly improve the success rate of surgery, and has a certain guiding significance for clinical treatment of glaucoma.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6

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