【摘要】：目的：探討針撥聯(lián)合氟尿嘧啶(5-FU)結(jié)膜下注射治療早、中期失敗濾過(guò)泡的安全性、有效性。并對(duì)可能影響針撥效果的因素進(jìn)行分析。 方法：我們對(duì)2008年3月-2010年6月山東省立醫(yī)院門(mén)診接診的行小梁切除術(shù)術(shù)后早、中期復(fù)診的患者中,有濾過(guò)泡形態(tài)不良、眼壓控制不佳的患者行濾過(guò)泡針撥聯(lián)合5-FU濾過(guò)泡旁結(jié)膜下注射。對(duì)于雙眼患者隨機(jī)選1眼為觀(guān)察對(duì)象,我們共對(duì)23眼進(jìn)行了觀(guān)察分析。在手術(shù)顯微鏡下操作,應(yīng)用1ml注射器針頭。針撥結(jié)束后5-FU0.2ml(25mg/mL)分兩點(diǎn)注射到濾過(guò)泡周?chē)Y(jié)膜下。妥布霉素地塞米松滴眼液(典必殊)點(diǎn)眼4次/日。于術(shù)后1周、2周、4周、8周、16周、20周、24周復(fù)診。對(duì)復(fù)診時(shí)的眼壓、濾過(guò)泡的形態(tài)及并發(fā)癥進(jìn)行觀(guān)察記錄。對(duì)針撥前后眼壓進(jìn)行統(tǒng)計(jì)分析,對(duì)濾過(guò)泡進(jìn)行Kaplan-Meier生存分析。對(duì)可能影響針撥效果的因素如既往眼手術(shù)史、針撥前濾過(guò)泡形態(tài)、針撥后即刻眼壓及濾過(guò)手術(shù)與針撥的時(shí)間間隔做統(tǒng)計(jì)處理。 結(jié)果：以如下標(biāo)準(zhǔn)進(jìn)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(yīng)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(rèn)為失敗。針撥前23眼眼壓21.9-35.0mmHg,平均26.5mHg±3.0,術(shù)后即刻眼壓7.7-18.5mmHg,平均12.6mmHg±5.9。在隨訪(fǎng)過(guò)程中有7眼眼壓升高,給予派立明或美開(kāi)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(fǎng)結(jié)束時(shí)16只眼為功能濾過(guò)泡;7只眼為非功能濾過(guò)泡。濾過(guò)泡的生存曲線(xiàn)分析結(jié)果表明,針撥后24周濾過(guò)泡生存率為69.6±0.9%(生存率±標(biāo)準(zhǔn)誤),23眼濾過(guò)泡的平均生存時(shí)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(jié)膜下出血4眼,虹膜炎癥反應(yīng)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(shù)史、針撥后即刻眼壓及濾過(guò)手術(shù)與針撥的時(shí)間間隔與針撥效果間無(wú)統(tǒng)計(jì)學(xué)意義。而針撥前濾過(guò)泡形態(tài)與針撥效果間有統(tǒng)計(jì)學(xué)意義,包裹型濾過(guò)泡針撥效果好于扁平型。 結(jié)論：針撥聯(lián)合5-FU結(jié)膜下注射是治療失敗濾過(guò)泡的有效方法。針撥操作簡(jiǎn)單、安全、具有可重復(fù)性。對(duì)手術(shù)設(shè)備要求低。在影響針撥效果的諸因素中,針撥前濾過(guò)泡形態(tài)與針撥效果間有統(tǒng)計(jì)學(xué)意義,包裹型濾過(guò)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(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R779.6

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