针拨联合5-FU结膜下注射治疗失败滤过泡的临床研究
发布时间：2018-12-18 02:52
【摘要】：目的：探讨针拨联合氟尿嘧啶(5-FU)结膜下注射治疗早、中期失败滤过泡的安全性、有效性。并对可能影响针拨效果的因素进行分析。 方法：我们对2008年3月-2010年6月山东省立医院门诊接诊的行小梁切除术术后早、中期复诊的患者中,有滤过泡形态不良、眼压控制不佳的患者行滤过泡针拨联合5-FU滤过泡旁结膜下注射。对于双眼患者随机选1眼为观察对象,我们共对23眼进行了观察分析。在手术显微镜下操作,应用1ml注射器针头。针拨结束后5-FU0.2ml(25mg/mL)分两点注射到滤过泡周围结膜下。妥布霉素地塞米松滴眼液(典必殊)点眼4次/日。于术后1周、2周、4周、8周、16周、20周、24周复诊。对复诊时的眼压、滤过泡的形态及并发症进行观察记录。对针拨前后眼压进行统计分析,对滤过泡进行Kaplan-Meier生存分析。对可能影响针拨效果的因素如既往眼手术史、针拨前滤过泡形态、针拨后即刻眼压及滤过手术与针拨的时间间隔做统计处理。 结果：以如下标准进行判断：完全有效：不用任何降眼压药,眼压低于21mmHg。部分有效：应用一种降眼压药,眼压低于21mmHg。失败：需要两种或两种以上的降眼压药,不论眼压是否正常,均认为失败。针拨前23眼眼压21.9-35.0mmHg,平均26.5mHg±3.0,术后即刻眼压7.7-18.5mmHg,平均12.6mmHg±5.9。在随访过程中有7眼眼压升高,给予派立明或美开朗1种降压药,眼压仍高于21mmHg。所有23眼末次眼压10.10-38.0mmHg,平均20.5mmHg±8.20。随访结束时16只眼为功能滤过泡;7只眼为非功能滤过泡。滤过泡的生存曲线分析结果表明,针拨后24周滤过泡生存率为69.6±0.9%(生存率±标准误),23眼滤过泡的平均生存时间20.52周±1.26,95%可信区间为18.05-22.99周。针拨并发症：针拨后浅前房、低眼压8眼,结膜下出血4眼,虹膜炎症反应3眼,前房出血2眼。在可能影响针拨效果的因素中既往眼手术史、针拨后即刻眼压及滤过手术与针拨的时间间隔与针拨效果间无统计学意义。而针拨前滤过泡形态与针拨效果间有统计学意义,包裹型滤过泡针拨效果好于扁平型。 结论：针拨联合5-FU结膜下注射是治疗失败滤过泡的有效方法。针拨操作简单、安全、具有可重复性。对手术设备要求低。在影响针拨效果的诸因素中,针拨前滤过泡形态与针拨效果间有统计学意义,包裹型滤过泡针拨效果好于扁平型。
[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 卤3.0) before acupuncture. The IOP was 7.7-18.5 mmHg immediately after operation, and the mean IOP was 12.6mmHg 卤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 卤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 卤0.9% (survival 卤standard error) at 24 weeks after needle removal, and the mean survival time of 23 eyes was 20.52 卤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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6
[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 卤3.0) before acupuncture. The IOP was 7.7-18.5 mmHg immediately after operation, and the mean IOP was 12.6mmHg 卤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 卤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 卤0.9% (survival 卤standard error) at 24 weeks after needle removal, and the mean survival time of 23 eyes was 20.52 卤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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6
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