本文關鍵詞：微型Ex-PRESS引流器植入術與復合式小梁切除術治療青光眼的療效比較，由筆耕文化傳播整理發(fā)布。

        背景和目的青光眼是一種伴有眼壓升高、神經(jīng)節(jié)細胞凋亡致視野缺損不斷進展的慢性視神經(jīng)性病變。流行病學資料顯示，預計到2020年全世界青光眼人數(shù)達8000萬，其中我國青光眼的發(fā)病人數(shù)高達600萬人。隨著社會、環(huán)境、生活習慣的改變及現(xiàn)代眼科技術的發(fā)展，我國青光眼的類型比例也發(fā)生改變，其中開角型青光眼的發(fā)病人數(shù)在增長。關于原發(fā)性青光眼致病基因的研究報道很多[1][2]，但致病基因導致青光眼的發(fā)病機制尚不十分清楚，目前基因治療仍處于動物試驗階段。青光眼發(fā)病的危險因素有眼壓、家族史、吸煙、高血壓、糖尿病、炎癥反應等，其中高眼壓是視功能受損最具預測性的危險因素，也是青光眼治療過程中的唯一可校正因素[3]。目前降低眼壓的方法主要有藥物、手術和激光。小梁切除術依然是主要的抗青光眼手術[4]，但其遠期的高失敗率和潛在的并發(fā)癥很多，不是最為理想的手術方式。近年來國外不斷報道“微型”引流裝置植入術治療青光眼，具有操作簡單、并發(fā)癥少、降壓效果明確等優(yōu)點。目前國內關于植入Ex-PRESS引流器治療青光眼的療效和并發(fā)癥的報道很少。本研究的目的是觀察Ex-PRESS引流器和復合式小梁切除術治療開角型青光眼的臨床療效，并比較兩種手術方式的治療效果。方法本研究為前瞻性研究。選擇于我院就診的青光眼患者53例（55眼），隨機分組為試驗組23例（25眼）采取Ex-PRESS引流器植入術；對照組30例（30眼）采取復合式小梁切除術。分別于術后1天、1周、1月、3月、6月記錄兩組的平均眼壓、視力、使用抗青光眼藥物數(shù)量、手術時間、手術成功率、和并發(fā)癥情況，并進行兩組間比較。所有數(shù)據(jù)用均數(shù)±標準差表示，數(shù)據(jù)統(tǒng)計分析由SPSS17.0軟件處理，以P<0.05為差異有統(tǒng)計學意義。結果1.Ex-PRESS組術后1天、1周、1月、3月、6月平均眼壓較術前相比，差異均有統(tǒng)計學意義（P<0.001）。2.Ex-PRESS組和小梁切除組的術后6月平均眼壓分別為（17.3±1.4）mm Hg，（17.5±1.1）mm Hg，兩組間相比差異無統(tǒng)計學意義。3.Ex-PRESS組和小梁切除組的手術時間分別為（23.5±2.3)min，（34.8±2.3）min，兩組間差異有統(tǒng)計學意義（P<0.001）；應用降眼壓藥物的數(shù)量分別為（0.3±0.6）,（0.4±0.7），兩組間差異無統(tǒng)計學意義。4.Ex-PRESS組和小梁切除組術后6個月的手術成功率分別為80.0%：76.7%，差異無統(tǒng)計學意義。5.Ex-PRESS組和小梁切除組總并發(fā)癥發(fā)生率分別為12.0%：36.7%，兩組相比差異有統(tǒng)計學意義（P<0.05）。結論1.微型Ex-PRESS引流器植入術具有明顯的降眼壓作用。2.微型Ex-PRESS引流器植入術的降低眼壓水平與復合式小梁切除術相當。3.與復合式小梁切除術相比，微型Ex-PRESS引流器植入術操作簡單，，手術時間短，對眼內組織騷擾小，術后并發(fā)癥更少，安全性更高。

    Background and objectivesGlaucoma was one of progressive optic neuropathies that were associated withelevated intraocular pressure, characteristic visual field defects following the ganglioncell apoptosis.Epidemiological data indicated that the number of glaucoma was80million by2020, including up to6million in China.With the change of the society,environment and living habits and the development of modern technology ofophthalmology, the proportion of glaucoma type in China also changed, including theprevalence of open-angle glaucoma increased. There were a lot of researches on geneof glaucoma[1][2], but the mechanism of disease genes resulting in glaucoma was notyet clear, the gene therapy was still in the experimental animals. The risk factors forglaucoma were intraocular pressure, family history, smoking, high blood pressure,diabetes, inflammatory reaction, etc., Elevated intraocular pressure was the mostpredictive risk factor for visual function damage, and was the only correction factorsof glaucoma treatment process[3]. At present the methods to reduce intraocularpressure were drugs, laser and surgery. Trabeculectomy was still the main glaucomasurgery[4]. As its long-term high failure rate and many potential complications, it wasnot the ideal operation. Research abroad in recent years had reported micro drainage device implantation treatment,with showing simple operation, less complications, ef-fective pressure reduction.We were unaware of any reported postoperative outcomeof the EX-PRESS in chinese patients.The purpose of this study was to compare theoutcome of the Ex-PRESS drainage versus trabeculectomy in open-angle glaucoma.MethodsA prospective study.53cases(55eyes) open-angle glaucoma patients withpreviously failed in the study.23cases(25eyes) were randomly divided into groupwich were treated by mini Ex-PRESS drainage implantation,the other30cases(30eyes)were treated by trabeculectomy. All of the eyes were measured the visualacuities, intraocular pressure, number of glaucoma medications, operation time,surgical success rate and complications at pre-operation,1day,1week,and1,3,6months after surgery.Results1.In Ex-PRESS group,the average IOP at1day,1week,1,3and6months aftersurgery was significant different from the preoperative level(P <0.001).2. In Ex-PRESS group and TE group,the average intraocular pressure at6months postoperatively was（17.3±1.4） mm H g,（17.5±1.1）mm Hg respectively,there had no statistically significant differences between the two groups.3. In Ex-PRESS group and TE group,the operation time was (23.5±2.3) min,(34.8±2.3) min respectively, there had statistically significant differences betweenthe two groups (P <0.001); The number of glaucoma medications was (0.3±0.6),(0.4±0.7), there had no difference between the two groups.4. In Ex-PRESS group and TE group, success rate at6months after surgery was80.0%,76.7%respectively.5.In Ex-PRESS group and TE group,total complication rates were12.0%,36.7%respectively,and there had significant differences between the two groups.(P <0.037). Conclusion1.The micro Ex-PRESS implantation can reduce intraocular pressure effectively.2.Trabeculectomy and the micro Ex-PRESS implantation provioded similar IOPcontrol.3.The micro Ex-PRESS drainage implantation had lower rates of hypotony andother post-complications compared to trabeculectomy.The first had shorter operationtime, and the higher level of security.

微型Ex-PRESS引流器植入術與復合式小梁切除術治療青光眼的療效比較

摘要4-6Abstract6-8中英文縮略詞對照10-11引言11-131 資料與方法13-152 研究方法15-173 結果17-204 討論20-255 結論25-26參考文獻26-28附圖28-29綜述29-49    參考文獻44-49個人簡介、在學期間發(fā)表的學術論文集研究成果49-50致謝50

  本文關鍵詞：微型Ex-PRESS引流器植入術與復合式小梁切除術治療青光眼的療效比較，由筆耕文化傳播整理發(fā)布。