【摘要】：目的：探討針撥聯(lián)合氟尿嘧啶(5-FU)結膜下注射治療早、中期失敗濾過泡的安全性、有效性。并對可能影響針撥效果的因素進行分析。 方法：我們對2008年3月-2010年6月山東省立醫(yī)院門診接診的行小梁切除術術后早、中期復診的患者中,有濾過泡形態(tài)不良、眼壓控制不佳的患者行濾過泡針撥聯(lián)合5-FU濾過泡旁結膜下注射。對于雙眼患者隨機選1眼為觀察對象,我們共對23眼進行了觀察分析。在手術顯微鏡下操作,應用1ml注射器針頭。針撥結束后5-FU0.2ml(25mg/mL)分兩點注射到濾過泡周圍結膜下。妥布霉素地塞米松滴眼液(典必殊)點眼4次/日。于術后1周、2周、4周、8周、16周、20周、24周復診。對復診時的眼壓、濾過泡的形態(tài)及并發(fā)癥進行觀察記錄。對針撥前后眼壓進行統(tǒng)計分析,對濾過泡進行Kaplan-Meier生存分析。對可能影響針撥效果的因素如既往眼手術史、針撥前濾過泡形態(tài)、針撥后即刻眼壓及濾過手術與針撥的時間間隔做統(tǒng)計處理。 結果：以如下標準進行判斷：完全有效：不用任何降眼壓藥,眼壓低于21mmHg。部分有效：應用一種降眼壓藥,眼壓低于21mmHg。失�。盒枰獌煞N或兩種以上的降眼壓藥,不論眼壓是否正常,均認為失敗。針撥前23眼眼壓21.9-35.0mmHg,平均26.5mHg±3.0,術后即刻眼壓7.7-18.5mmHg,平均12.6mmHg±5.9。在隨訪過程中有7眼眼壓升高,給予派立明或美開朗1種降壓藥,眼壓仍高于21mmHg。所有23眼末次眼壓10.10-38.0mmHg,平均20.5mmHg±8.20。隨訪結束時16只眼為功能濾過泡;7只眼為非功能濾過泡。濾過泡的生存曲線分析結果表明,針撥后24周濾過泡生存率為69.6±0.9%(生存率±標準誤),23眼濾過泡的平均生存時間20.52周±1.26,95%可信區(qū)間為18.05-22.99周。針撥并發(fā)癥：針撥后淺前房、低眼壓8眼,結膜下出血4眼,虹膜炎癥反應3眼,前房出血2眼。在可能影響針撥效果的因素中既往眼手術史、針撥后即刻眼壓及濾過手術與針撥的時間間隔與針撥效果間無統(tǒng)計學意義。而針撥前濾過泡形態(tài)與針撥效果間有統(tǒng)計學意義,包裹型濾過泡針撥效果好于扁平型。 結論：針撥聯(lián)合5-FU結膜下注射是治療失敗濾過泡的有效方法。針撥操作簡單、安全、具有可重復性。對手術設備要求低。在影響針撥效果的諸因素中,針撥前濾過泡形態(tài)與針撥效果間有統(tǒng)計學意義,包裹型濾過泡針撥效果好于扁平型。
[Abstract]:Objective: to investigate the safety and efficacy of acupuncture combined with fluorouracil (5-FU) subconjunctival injection in the treatment of early and middle stage failed filtering blebs. The factors that may affect the effect of acupuncture are analyzed. Methods: from March 2008 to June 2010, we performed trabeculectomy in Shandong Provincial Hospital from March 2008 to June 2010. Patients with poor intraocular pressure control were given subconjunctival injection of filtration needle combined with 5-FU filtration. We observed and analyzed 23 eyes of binocular patients randomly. 1ml syringe needle was used to operate under the operation microscope. After acupuncture, 5-FU0.2ml (25mg/mL) was injected into the perifollicular conjunctiva at two points. Tobramycin dexamethasone eye drops (Dianbishu) 4 times a day. Follow up at 1 week, 2 weeks, 4 weeks, 8 weeks, 16 weeks, 20 weeks, 24 weeks postoperatively. The intraocular pressure (IOP), the morphology of filtering bleb and complications were observed and recorded. Intraocular pressure (IOP) before and after acupuncture was statistically analyzed and Kaplan-Meier survival analysis was performed on filtering blebs. The factors that may affect the effect of acupuncture, such as the history of previous eye operation, the morphology of filtering bleb before needle removal, the immediate intraocular pressure after needle removal and the interval between filtering operation and needle transfer, were statistically analyzed. Results: according to the following criteria: completely effective: no IOP lowering drugs, IOP less than 21 mm Hg. Partial efficacy: use a IOP lowering drug, IOP less than 21 mm Hg. Failure: two or more IOP relievers are required, whether or not IOP is normal. The intraocular pressure (IOP) of 23 eyes was 21.9-35.0mmHg (mean 26.5mHg 鹵3.0) before acupuncture. The IOP was 7.7-18.5 mmHg immediately after operation, and the mean IOP was 12.6mmHg 鹵5.9 mm. During the follow-up period, intraocular pressure increased in 7 eyes. The intraocular pressure was still higher than 21 mm Hg. The final intraocular pressure (IOP) of all 23 eyes was 10.10 ~ 38.0 mm Hg (mean 20.5mmHg 鹵8.20). Functional blebs were found in 16 eyes and non-functional blebs in 7 eyes at the end of follow-up. The results of survival curve analysis showed that the survival rate was 69.6 鹵0.9% (survival 鹵standard error) at 24 weeks after needle removal, and the mean survival time of 23 eyes was 20.52 鹵1.2695% confidence interval (18.05-22.99 weeks). Complications of acupuncture: superficial anterior chamber, low intraocular pressure (8 eyes), subconjunctival hemorrhage (4 eyes), iris inflammation (3 eyes) and anterior chamber hemorrhage (2 eyes). Among the factors that may affect the effect of acupuncture, there was no statistical significance between the immediate intraocular pressure after acupuncture and the time interval between filtering operation and needle transfer and the effect of acupuncture. However, there was significant difference between the pattern of filter bleb and the effect of needle removal. The effect of wrapped filter bleb was better than that of flat one. Conclusion: acupuncture combined with subconjunctival injection of 5-FU is an effective method for the treatment of failed filtering blebs. Needle-dial operation is simple, safe and repeatable. Low requirements for surgical equipment. Among the factors affecting the effect of needle removal, there was a significant difference between the pattern of filter bleb before needle removal and the effect of needle pulling, and the effect of wrapped filter bleb was better than that of flat type.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R779.6

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