傳統小梁切除術中使用絲裂霉素C與5-氟尿嘧啶療效與安全性的系統評價_《中國循證醫學雜志》

作者：

1. 新疆醫科大學第一附屬醫院眼科（烏魯木齊 830054）； 2. 新疆醫科大學第一附屬醫院循證醫學中心（烏魯木齊 830054）;

關鍵詞：

絲裂霉素C 5-氟尿嘧啶傳統小梁切除術青光眼療效隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20100484

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目的　系統評價傳統小梁切除術中使用絲裂霉素C（MMC）與5-氟尿嘧啶（5-Fu）的療效及安全性。
方法　計算機檢索MEDLINE（1966～2008年10月）、EMbase（1966～2008年10月）、Cochrane協作網眼和視力組（2008年3期）數據庫及中國生物醫學文獻數據庫（1979～2008年10月），并采用手工檢索等方法收集會議文獻，收集所有相關隨機對照試驗。在評價納入研究的方法學質量后采用RevMan 5.0軟件進行Meta分析。
結果　共納入9個隨機對照試驗，包括482例患者（495只患眼）。Meta分析結果表明，在手術失敗高風險組中，與MMC相比，5-Fu可增加術后并發癥發生率［RR=–5.74，95%CI（–9.91，–1.58）］；應用MMC與5-Fu對傳統小梁切除術后眼壓降低率［WMD=–2.31，95%CI（–7.34，2.71）］、手術成功率［RR=1.13，95%CI（0.91，1.39）]、術后視力下降（≥3行）［RR=1.46，95%CI（0.43，4.94）］差異均無統計學意義；在手術失敗低風險組中，應用MMC與5-Fu在傳統小梁切除術后手術成功率及術后并發癥發生率方面差異均無統計學意義［RR=1.10，95%CI（0.99，1.22）；RR=1.00，95%CI（–6.21，8.21）］。
結論　傳統性小梁切除術手術失敗高風險組和低風險組中，使用MMC和5-Fu對手術成功率、術后視力變化等方面差異均無統計學意義；但在高風險組中5-Fu可增加術后并發癥發生率，MMC與5-Fu對傳統小梁切除術后眼壓降低率的作用何者更優尚不確定。但在傳統小梁切除術中，兩種藥物用藥方式對藥代動力學的影響機制，以及經濟學評價尚待進一步研究。因本系統評價納入研究病例數較少，上述結論有待更多設計嚴謹的大樣本隨機對照試驗加以驗證，以增強論證強度。

引用本文： 米娜瓦爾阿不都,陳雪藝,具爾提哈地爾,艾克萊穆艾爾肯. 傳統小梁切除術中使用絲裂霉素C與5-氟尿嘧啶療效與安全性的系統評價. 中國循證醫學雜志, 2010, 10(6): 730-739. doi: 10.7507/1672-2531.20100484 復制

1.	Morrison JC. Glaucoma science and practice. Thieme New York.Stuttgart 2003, epidemiology of glaucoma: 2 Filtration surgery: 463-464.
2.	SK Law, T Li. Acupuncture for glaucoma. Cochrane Database Syst Rev, 2007, 17(4): CD006030.
3.	Rossetti L, Marchetti I, Orzalesi N, et al. Randomized clinical trials on medical treatment of glaucoma. Are they appropriate to guide clinical practice? Arch Ophthal, 1993, 111(1): 96-103.
4.	de Moura CR, Paranhos A, Wormald R. Laser trabeculoplasty for open angle glaucoma. Cochrane Database Syst Rev, 2007, 17(4):CD003919.
5.	Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol, 1968, 66(4): 673-679.
6.	Kanski JJ. Clinical ophthalmology, Edinburgh. Butterworth-Heinemann, 2003.Gluacoma: 259-260.
7.	Wilkins M, Indar A, Wormald R. Intra-operative Mitomycin C for glaucoma surgery. Cochrane Database of Systematic Reviews 19 October 2005 in Issue 4. Art. No.: CD002897. DOI:10.1002/14651858.CD002897.pub2.
8.	Wu DD, Cantor LB, Palanca-Capistrano AM, et al. A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy. Am J Ophthalmol, 2002, 134(4): 521-528.
9.	Katz GJ, Higginbotham EJ, Lichter PR, et al. Mitomycin C versus 5-fluorouracil in high-risk glaucoma filtering surgery. Extended follow-up. Ophthalmology, 1995, 102(9): 1263-1269.
10.	吳泰相, 劉關鍵. 隱蔽分組(分配隱藏)和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
11.	Singh K, Egbert PR, Byrd S, et al. Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C. Am J Ophthalmol, 1997, 123(1): 48-53.
12.	Singh K, Mehta K, Shaikh NM, et al. Trabeculectomy with intraoperative mitomycin C versus 5-fluorouracil. Prospective randomized clinical trial. Ophthalmology, 2000, 107(12): 2305-2309.
13.	Sisto D, Vetrugno M, Trabucco T, et al. The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up. Acta Ophthalmol Scand, 2007, 85(3): 267-271.
14.	Palanca-Capistrano AM, Hall J, Cantor LB, et al. Long-term Outcomes of Intraoperative 5-Fluorouracil versus Intraoperative Mitomycin C in Primary Trabeculectomy Surgery. Ophthalmology, 2009, 116(2): 185-190.
15.	Lamping KA, Belkin JK. 5-Fluorouracil and mitomycin C in pseudophakic patients. Ophthalmology, 1995, 102(1): 70-75.
16.	Skuta GL, Beeson CC, Higginbotham EJ, et al. Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery. Ophthalmology, 1992, 99(3): 438-444.
17.	Kitazawa Y, Kawase K, Matsushita H, et al. Trabeculectomy with mitomycin. A comparative study with fluorouracil. Arch Ophthalmol, 1991, 109(12): 1693-1698.
18.	Capistrano AP, WuDunn D, Cantor LB. Comparison of IOP control when using intraoperative 5-fluorouracil versus mitomycin C at six and twelve months in primary trabeculectomy, IOVS. Volume 42ARVO Abstract 2971, 2001.
19.	Barton K, Franks WA, Vunce C. Long-term outcome of MMC vs 5-Fu trabeculectomy in uveitic glaucoma, IOVS. Volume 45ARVO E-abstract 991, 2004.
20.	Barton K, Franks WA, Pavesio CE. A prospective comparison of intraoperative 5-fluorouracil versus mitomycin C trabeculectomy in uveitic glaucoma, IOVS. Volume 42ARVO Abstract 580, 2001.
21.	Vijaya L, Mukhesh BN, Shantha B, et al. Comparison of low-dose intraoperative mitomycin-C vs 5-fluorouracil in primary glaucoma surgery: a pilot study. Ophthalmic Surg Lasers, 2000, 31(1): 24-30.
22.	Robin AL, Ramakrishnan R, Krishnadas R, et al. A long-term dose-response study of mitomycin in glaucoma filtration surgery. Arch Ophthalmol, 1997, 115(8): 969-974.
23.	李美玉. 主編. 青光眼學. 北京: 人民衛生出版社, 2004: 前言, 589.

1. Morrison JC. Glaucoma science and practice. Thieme New York.Stuttgart 2003, epidemiology of glaucoma: 2 Filtration surgery: 463-464.
2. SK Law, T Li. Acupuncture for glaucoma. Cochrane Database Syst Rev, 2007, 17(4): CD006030.
3. Rossetti L, Marchetti I, Orzalesi N, et al. Randomized clinical trials on medical treatment of glaucoma. Are they appropriate to guide clinical practice? Arch Ophthal, 1993, 111(1): 96-103.
4. de Moura CR, Paranhos A, Wormald R. Laser trabeculoplasty for open angle glaucoma. Cochrane Database Syst Rev, 2007, 17(4):CD003919.
5. Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol, 1968, 66(4): 673-679.
6. Kanski JJ. Clinical ophthalmology, Edinburgh. Butterworth-Heinemann, 2003.Gluacoma: 259-260.
7. Wilkins M, Indar A, Wormald R. Intra-operative Mitomycin C for glaucoma surgery. Cochrane Database of Systematic Reviews 19 October 2005 in Issue 4. Art. No.: CD002897. DOI:10.1002/14651858.CD002897.pub2.
8. Wu DD, Cantor LB, Palanca-Capistrano AM, et al. A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy. Am J Ophthalmol, 2002, 134(4): 521-528.
9. Katz GJ, Higginbotham EJ, Lichter PR, et al. Mitomycin C versus 5-fluorouracil in high-risk glaucoma filtering surgery. Extended follow-up. Ophthalmology, 1995, 102(9): 1263-1269.
10. 吳泰相, 劉關鍵. 隱蔽分組(分配隱藏)和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
11. Singh K, Egbert PR, Byrd S, et al. Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C. Am J Ophthalmol, 1997, 123(1): 48-53.
12. Singh K, Mehta K, Shaikh NM, et al. Trabeculectomy with intraoperative mitomycin C versus 5-fluorouracil. Prospective randomized clinical trial. Ophthalmology, 2000, 107(12): 2305-2309.
13. Sisto D, Vetrugno M, Trabucco T, et al. The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up. Acta Ophthalmol Scand, 2007, 85(3): 267-271.
14. Palanca-Capistrano AM, Hall J, Cantor LB, et al. Long-term Outcomes of Intraoperative 5-Fluorouracil versus Intraoperative Mitomycin C in Primary Trabeculectomy Surgery. Ophthalmology, 2009, 116(2): 185-190.
15. Lamping KA, Belkin JK. 5-Fluorouracil and mitomycin C in pseudophakic patients. Ophthalmology, 1995, 102(1): 70-75.
16. Skuta GL, Beeson CC, Higginbotham EJ, et al. Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery. Ophthalmology, 1992, 99(3): 438-444.
17. Kitazawa Y, Kawase K, Matsushita H, et al. Trabeculectomy with mitomycin. A comparative study with fluorouracil. Arch Ophthalmol, 1991, 109(12): 1693-1698.
18. Capistrano AP, WuDunn D, Cantor LB. Comparison of IOP control when using intraoperative 5-fluorouracil versus mitomycin C at six and twelve months in primary trabeculectomy, IOVS. Volume 42ARVO Abstract 2971, 2001.
19. Barton K, Franks WA, Vunce C. Long-term outcome of MMC vs 5-Fu trabeculectomy in uveitic glaucoma, IOVS. Volume 45ARVO E-abstract 991, 2004.
20. Barton K, Franks WA, Pavesio CE. A prospective comparison of intraoperative 5-fluorouracil versus mitomycin C trabeculectomy in uveitic glaucoma, IOVS. Volume 42ARVO Abstract 580, 2001.
21. Vijaya L, Mukhesh BN, Shantha B, et al. Comparison of low-dose intraoperative mitomycin-C vs 5-fluorouracil in primary glaucoma surgery: a pilot study. Ophthalmic Surg Lasers, 2000, 31(1): 24-30.
22. Robin AL, Ramakrishnan R, Krishnadas R, et al. A long-term dose-response study of mitomycin in glaucoma filtration surgery. Arch Ophthalmol, 1997, 115(8): 969-974.
23. 李美玉. 主編. 青光眼學. 北京: 人民衛生出版社, 2004: 前言, 589.

《中國循證醫學雜志》

傳統小梁切除術中使用絲裂霉素C與5-氟尿嘧啶療效與安全性的系統評價

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《中國循證醫學雜志》

傳統小梁切除術中使用絲裂霉素C與5-氟尿嘧啶療效與安全性的系統評價

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