引流物植入术对青光眼疗效的临床应用研究

发布时间：2018-05-19 20:25

本文选题：青光眼引流物 + 小梁切除术　；参考：《兰州大学》2017年硕士论文

【摘要】：目的通过检索文献及系统评价的方法探讨不同手术应用于青光眼的疗效差异,为临床治疗青光眼的方式选择提供依据。方法选用“小梁切除术”、“青光眼阀”、“青光眼引流器”为中文检索词,检索中国知网、中国生物医学文献数据库、和万方数据库中公开发表的中文文献,选用“glaucoma drainage implant”,“trabeculectomy”,“glaucoma filtration implant”,“aqueous shunt”为英文检索词,检索Pubmed,Web of science,EMBASE,Cochrane Library数据库中公开发表的英文文献,检索年限为1983年至2015年。Endnote软件和手工剔除重复文献,两位研究员按照纳入、排除的标准筛选文献,质量评价。按纳入排除标准最终筛选出相关文献4篇。按文献选入参数:眼压下降百分率(IOPR%);手术后1年时未使用降眼压药物达到目标眼压的成功率、手术后1年时使用降眼压药物达到目标眼压的成功率;术后浅前房发生率、术后前房积血发生率、术后切口渗漏发生率。文献中113例接受EX-PRESS青光眼引流器植入术,59例接受Ahmed青光眼阀植入术,作为此次研究的干预组(GDD组);179例接受青光眼小梁切除术作为对照组(Tra组)。用Rev Man5.2软件对纳入的文献进行meta分析。结果控制眼压,两组的眼压下降百分率(IOPR%)无明显统计学差异,(MD=-0.59;95%CI,-7.48-6.29;P=0.87),两组手术降低眼压效果相似;手术后1年患者未使用抗青光眼药物达到目标眼压(5IOP18mm Hg)的手术成功率,GDD组优于Tra组,结果有明显统计学差异(OR=5.80;95%CI,2.14-15.71,P=0.0006);手术后1年患者使用抗青光眼药物达到目标眼压(5IOP18mm Hg)的手术成功率,GDD组优于Tra组,具有统计学差异(OR=2.51;95%CI,1.25-5.05;P=0.010);手术后浅前房发生率,两组无明显统计学差异(OR=0.95;95%CI,0.52-1.75,P=0.87);手术后前房积血发生率,两组无明显统计学差异(OR=0.52;95%CI,0.22-1.22,P=0.13);手术后伤口渗漏发生率,两组无明显统计学差异(OR=0.59;95%CI,0.20-1.75,P=0.34),GDD组未使手术后并发症的发生率增加。结论青光眼引流物植入术与小梁切除术控制眼压效果及安全性相仿;青光眼引流物植入术能显著提高手术成功率,对临床治疗青光眼具有一定的指导意义。
[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.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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