本文選題：鞏膜池 + 小梁切除術(shù)�。� 參考：《南昌大學(xué)》2011年碩士論文

【摘要】：目的： 通過比較兔鞏膜池小梁切除術(shù)和常規(guī)小梁切除術(shù)后葡萄膜鞏膜途徑房水引流的形態(tài)學(xué)變化,探討鞏膜池小梁切除術(shù)可能的降壓機(jī)制。 對象和方法： 1、實驗對象及分組：成年新西蘭白兔30只60眼,體重2.5-3.0Kg,按隨機(jī)數(shù)字表法,隨機(jī)挑選20只40眼為實驗組,右眼行鞏膜池小梁切除術(shù)為實驗組Ⅰ,左眼行常規(guī)小梁切除術(shù)為實驗組Ⅱ。另10只20眼為空白對照組未行任何手術(shù)。 2、手術(shù)方法：以穹窿部為基底的結(jié)膜瓣。實驗組Ⅰ做以角膜緣為基底,厚為鞏膜1/3的鞏膜瓣,約4mm×4mm大小,剝離至透明角膜緣內(nèi)1mm。在淺層鞏膜瓣下的深層鞏膜上,再做同樣基底的1/3鞏膜厚的中層鞏膜瓣(大小約3mm×3mm),將其切除。沿角鞏膜后緣水平剪下2mm×1mm的深層組織,10/0線間斷縫合鞏膜瓣,水密縫合結(jié)膜瓣。實驗組Ⅱ按常規(guī)小梁切除術(shù)操作。 3、術(shù)后觀察：術(shù)后1周每天裂隙燈觀察角膜,前房反應(yīng),濾過泡,眼底情況等。記錄濾過泡比例,監(jiān)測術(shù)前、術(shù)后眼壓變化,并記錄數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析。UBM觀察濾過口、流出道及睫狀體的情況。挑選無并發(fā)癥模型進(jìn)行下一步研究。 4、熒光示蹤劑實驗：術(shù)后1周,取實驗組Ⅰ、實驗組Ⅱ各10眼,空白組5只10眼,前房穿刺注入2mg/ml FITC-Dextran示蹤劑10μl,于2,4,6,8,10h,各處死實驗組Ⅰ、實驗組Ⅱ各2眼,空白組1只2眼,迅速摘除眼球,作冰凍切片,熒光顯微鏡下觀察睫狀體、房水池、脈絡(luò)膜上腔、前、后鞏膜和脈絡(luò)膜的熒光強(qiáng)度等級。 5、HRP追蹤實驗：術(shù)后1周,另取實驗組Ⅰ、實驗組Ⅱ各10眼,空白組5只10眼,前房穿刺注入0.2mg/mlHRP10μ1,60 min后經(jīng)頸動脈灌注固定液350ml,迅速摘取眼球,作冰凍切片,觀察HRP隨房水流動的分布情況。并行MASSION染色觀察濾過道膠原纖維增生情況及睫狀體有無脫離。 結(jié)果： 1、手術(shù)結(jié)果：實驗組工和實驗組Ⅱ術(shù)前眼壓比較,差異無統(tǒng)計學(xué)意義(18.64±2.68mmHg,18.37±2.75mmHg,t值0.32,P=0.96),術(shù)后1周實驗組Ⅰ和實驗組Ⅱ眼壓較術(shù)前相比均明顯降低,兩組眼壓比較,差異無統(tǒng)計學(xué)意義(13.07±2.66mmHg,13.31±2.50mmHg,t值0.3,P=0.29)。 2、熒光示蹤劑結(jié)果：術(shù)后1周實驗組間各部位熒光強(qiáng)度比較均為：睫狀體、鞏膜池、脈絡(luò)膜上腔熒光強(qiáng)度最強(qiáng),前鞏膜次之,后鞏膜、脈絡(luò)膜的熒光強(qiáng)度最低。實驗組Ⅰ葡萄膜鞏膜途徑各部位的熒光強(qiáng)度均強(qiáng)于實驗組Ⅱ、空白對照組(P0.01)。空白對照組葡萄膜鞏膜途徑各部位熒光強(qiáng)度強(qiáng)于實驗組Ⅱ(P0.01)。 3、HRP追蹤結(jié)果：術(shù)后1周,實驗組Ⅰ結(jié)膜下、小梁網(wǎng)見散在的棕黃色HRP顆粒分布,睫狀體間隙、睫狀體上腔、鞏膜瓣下、脈絡(luò)膜、脈絡(luò)膜上腔均可見密集的HRP顆粒呈強(qiáng)染色；實驗組Ⅱ結(jié)膜下見密集的HRP顆粒呈強(qiáng)染色,睫狀體間隙、小梁網(wǎng)見棕黃色HRP顆粒散在分布,鞏膜瓣下、脈絡(luò)膜、脈絡(luò)膜上腔見少量HRP顆粒呈弱染色,睫狀體上腔未見明顯HRP顆粒分布�？瞻讓φ战M結(jié)膜下、小梁網(wǎng)、睫狀體間隙、虹膜睫狀體突見散在的HRP顆粒分布,脈絡(luò)膜、脈絡(luò)膜上腔見少量HRP顆粒分布。 結(jié)論： 1.兔鞏膜池小梁切除術(shù)與常規(guī)小梁切除術(shù)早期降壓效果相似。 2.兔鞏膜池小梁切除術(shù)后早期房水除常規(guī)小梁切除濾過口外引流外,通過鞏膜池還增加了房水葡萄膜鞏膜途徑引流。 3.用FITC-Dextran示蹤劑和HRP追蹤結(jié)果提示：兔鞏膜池小梁切除術(shù)后的早期葡萄膜鞏膜途徑房水引流較常規(guī)小梁切除術(shù)明顯增加。葡萄膜鞏膜途徑房水引流是兔鞏膜池小梁切除術(shù)后早期降眼壓的主要機(jī)制之一
[Abstract]:Objective:
The possible hypotensive mechanism of the scleral pool trabeculectomy was discussed by comparing the morphological changes of the aqueous drainage of the vineal sclera after the scleral pool trabeculectomy and conventional trabeculectomy.
Objects and methods:
1, the subjects and groups: 30 adult New Zealand white rabbits with 60 eyes and weight 2.5-3.0Kg. According to the random number table method, 20 40 eyes were randomly selected as the experimental group. The right eye was treated with scleral pool trabeculectomy in the experimental group I, the left eye underwent conventional trabeculectomy for the experimental group II. The other 10 20 eyes had no operation in the blank control group.
2, the surgical method: the conjunctival flap based on the fornix. The experimental group I made the sclera flap with the corneal limbus as the base and the thick sclera 1/3, about 4mm x 4mm size, peeled off to the deep sclera under the superficial sclera flap of the transparent limbus, and then made the same basal sscleral thick sclera flap (size about 3mm x 3mm), and removed it. Along the cornea, the sclera was removed. The sclera was removed. The sclera was removed along the corneo sclera. At the posterior edge of the membrane, the deep tissue of 2mm * 1mm was cut horizontally, the scleral flap was sutured intermittently on 10/0 line, and the conjunctival flap was sutured by water tight.
3, postoperative observation: 1 weeks after the operation, the cornea, anterior chamber reaction, filter bubble, and fundus were observed every day after 1 weeks of operation. The ratio of filter bubbles was recorded, the changes of intraocular pressure before and after operation were monitored, and the data were recorded by.UBM to observe the condition of filter, outflow and ciliary body.
4, fluorescence tracer experiment: 1 weeks after the operation, the experimental group I was taken, 10 eyes in the experimental group and 5 in the blank group, 10 eyes in the blank group, the anterior chamber puncture injection of 2mg/ml FITC-Dextran tracer 10 U L, each of the experimental group I, the experimental group II each 2 eyes, the blank group 1 2 eyes, the rapid removal of eye ball, frozen section, fluorescence microscope observation of ciliary body and the chamber pool, The intensity of fluorescence intensity in the choroidal cavity, anterior, posterior sclera and choroid.
5, HRP tracking experiment: 1 weeks after operation, another group I was taken, 10 eyes in the experimental group and 5 in 10 eyes of the blank group. The anterior chamber puncture was injected into 0.2mg/mlHRP10 mu 1,60 min and 350ml was injected through the carotid artery. The eyeball was quickly extracted and frozen, and the distribution of HRP with the flow in the room was observed. Parallel MASSION staining was used to observe the proliferation of the collagen fiber in the filter channel. Whether or not the ciliary body is divorced from the condition.
Result錛，

本文編號：2002374