不同手术方式治疗闭合性眼外伤继发难治性青光眼的临床观察

摘要

目的 探讨分析闭合性眼外伤继发难治性青光眼不同手术方式的临床效果.方法 对山西省大同市第五人民医院2008年1月至2012年1月收治的81例闭合性眼外伤继发难治性青光眼患者,按照不同手术方式分为A组(29例,行内窥镜引导睫状突光凝治疗)、B组(25例,行引流物植入手术治疗)与C组(27例,行小梁切除手术联合丝裂霉素C治疗),对比分析3组患者的手术效果.结果 随访3个月,A、B组患者手术治疗后与治疗前相比,平均眼压均明显降低(均 P ＜0.05)；A组患者手术成功率75.9％(22/29),与B组的76.0％(19/25)相比,差异无统计学意义(P＞0.05),均高于C组的48.2％(13/27)(P＜0.01)；A、B组患者术后并发症发生率分别为24.1％ (7/29)和24.0％(6/25),均明显低于C组51.8％(14/27)(均P＜0.05).结论 对闭合性眼外伤继发难治性青光眼患者,采用内窥镜引导睫状突光凝术及引流物植入术,手术成功率大,术后并发症少,但术前应注意把握患者的手术适应证,选择合适的手术方式.%Objective To investigate the clinical effect of different operation methods on closed injury of eyes with refractory glaucoma.Methods Totally 81 cases of closed traumatic secondary glaucoma,hospitalized in the Fifth people(s) hospital of Datong,were divided into group A(29 cases),group B(25 cases) and group C(27 cases) according to different operation methods of endoscopic cyclophotocoagulation,drainage implantation and trabeculectomy combined with mitomycin C (MMC),and the treatment effects of the three operation means have been compared and analyzed.Results All of the 81 operation treatments in three groups were followed up with regular visits in 3 months after treatment,and the average intraocular pressure was decreased significantly (P ＜ 0.05) ; the operation success rate of group A was 75.9％ (with 22 successes in all 29 cases),meanwhile,the success rate of group B was 76.0％ (with19 successes in all 25 cases),and the result was of no statistical significance (P ＞ 0.05),however,the success rate of either group A or B was higher than that of group C (48.2％,with only 13 successes in all 27 cases) (P ＜ 0.01) ; the incidence rates of postoperative complications were respectively 24.1％in group A and 24.0％ in group B,which were significantly lower than that in group C (51.8％) (P ＜0.05).Conclusions If traumatic secondary glaucoma patients are treated by endoscopic cyclophotocoagulation operation and drainage implantation operation,the success rate is high.But the specific symptoms of different patients should be taken into consideration regarding choosing suitable operation method before operation.