【摘要】 目的:探讨带蒂结膜瓣转移联合应用丝裂霉素C治疗复发性翼状胬肉的临床疗效。方法: 对 26例（26眼）复发性翼状胬肉患者，采用翼状胬肉切除、术中加用丝裂霉素C并行带蒂结膜瓣转移、术后低浓度丝裂霉素C点眼进行治疗并随访观察。结果:所有患者均接受了6～12mo随访，有1例患者复发，复发率为4%。没有并发症发生。结论:对复发性翼状胬肉，翼状胬肉切除术中加用带蒂结膜瓣转移联合应用丝裂霉素C，是一种有效的治疗方法。
【关键词】 翼状胬肉；结膜瓣转移；丝裂霉素C
Effects of pedical flap transposition of conjunctiva with mitomycin C treatment in recurrent pterygium surgery
HuaNing She, YanLong Quan, XiaoHua Wang, BaiChao Ren
Department of Ophthalmology, the Second Afflicated Hospital, Xian Jiaotong University Medical School, Xian 710004, Shaanxi Province, China
AbstractAIM: To evaluate the efficacy and safety of pedical flap transposition of conjunctiva with mitomycin C treatment in recurrent pterygium surgery. METHODS: Twentysix cases (26 eyes) with recurrent pterygium received pterygium excision operation. During the surgery, the entire pterygium was excised to the plica; bare sclera was exposed to 0.4g/L mitomycin C for 3 minutes; pedical flap transposition of conjunctiva was placed over the corneal and conjunctival defects and sutured with 8 0 Vicryl interrupted sutures. Postoperatively, the eyes were treated with 0.2g/L mitomycin C drops and were followed up. RESULTS: All cases were followed up for 612 months. Pterygium recurrence appeared in one eye, the recurrence rate was 4%, and no serious complications were observed.
CONCLUSION: Pedical flap transposition of conjunctiva with topical mitomycin C is an effect method for recurrent pterygium treatment, with low recurrence rate and little serious complications.
KEYWORDS: pterygium; mitomycin C; transposition of conjunctiva; surgery
0引言
翼状胬肉是眼科常见的一种慢性眼表疾病，除影响美观外，还引起眼部刺激症状，若胬肉直接长入角膜瞳孔区会导致视力下降，严重的复发性翼状胬肉可引起眼球粘连、眼球运动受限等并发症[1]。翼状胬肉的病因复杂，目前的治疗方法主要是施行手术切除。但传统的术式术后复发率高，翼状胬肉切除术后复发率高达20%～40%[2]。翼状胬肉术后一旦复发则生长迅速，治疗困难。文献报道翼状胬肉切除联合丝裂霉素Ｃ的治疗，可降低术后复发，我们亦做过报道[3]。近年来，对复发性翼状胬肉，我们采用翼状胬肉切除、带蒂结膜瓣转移联合丝裂霉素C进行治疗，效果良好,现报告如下。
1对象和方法
1.1对象
选自在我院眼科门诊和住院就诊的复发性翼状胬肉患者26例(26眼)，其中男18眼，女8眼，年龄35～65(平均48.7)岁。
1.2方法
常规消毒，表面麻醉后开睑器开睑。向翼状胬肉体部注射的20g/L利多卡因0.5mL。齿镊夹住胬肉头部，用刀片从头部前0.5mm角膜侧开始分离，分离至内直肌止端之前，将胬肉切除。彻底清除角膜巩膜创面上残存的胬肉组织，暴露健康的巩膜组织。将浓度为0.4g/L的丝裂霉素C棉片(5mm×4mm)置于裸露的巩膜创面上，3min后去除，用生理盐水彻底冲洗术野、角膜及上下穹窿部结膜。在角膜缘上方作一蒂在鼻上方结膜的5mm×8mm大小、长方形结膜瓣，扭转向下覆盖在巩膜裸露区。用8 0丝线缝合固定。穹窿结膜下注射地塞米松2mg。术毕单眼包扎。术后5d拆线。术后第1wk每日换药，庆大霉素稀释液冲洗，新霉素地塞米松眼液滴眼。术后第3wk用0.2g/L丝裂霉素C溶液术区点眼，2次/d,持续2wk。术后第1wk每日裂隙灯下观察1次；术后第1mo每周裂隙灯下观察1次；以后每3mo观察1次。术后随访6～12mo。重点观察:(1)角膜上皮愈合情况;(2)结膜伤口愈合情况；(3)手术区有无纤维血管膜样组织增生；(4)巩膜、房水有无异常及并发症。
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