【摘要】 目的:探讨翼状胬肉切除联合使用丝裂霉素 C(mitomycin C,MMC)术后巩膜溶解的发生机制及预防、治疗。方法:对2005/2009年我院收治的7例翼状胬肉切除联合MMC术后巩膜溶解患者进行相关检查,并通过局部药物或手术方法进行治疗。结果:患者7例均无全身免疫性疾病病史,且全身检查亦未发现免疫性疾病的表现。所有患者病变位于原翼状胬肉切除部位,且局部表现为组织缺血,变薄,部分患者病变区域可透见深层色素组织,甚至形成巩膜葡萄肿。通过局部药物或手术治疗,病情得到控制,且在随访期间无复发。结论:翼状胬肉切除手术为降低复发率,可采用联合MMC治疗,但是在MMC的浓度及作用时间上应慎重选择,并且术中应尽量减少局部组织的烧灼,以保证局部的血液供应,预防巩膜溶解的发生。
【关键词】 翼状胬肉;巩膜溶解;丝裂霉素C
Analysis on scleral melting after pterygium excision with mitomycin C HouCheng Liang1, HongGang Wang2, Tan Long1, Ting Ma1 Xian Eye Hospital, Eye Research Institute of Shaanxi Province, Xian 710002, Shaanxi Province,China; Depratment of Ophthalmology,Hospital of Chengcheng County, Chengcheng County 715200, Shaanxi Province, China AbstractAIM: To discuss the mechanism, prevention and therapy of the scleral melting after pterygium excision with intraoperative application of mitomycin C(MMC). METHODS: Seven patients with scleral melting after pterygium excision with MMC were examined and treated with topical drugs or surgery. RESULTS:Neither history nor positive manifestation of immunological diseases were found by physical examination. But the ischemic, attenuating could be found at the tissue where the pterygium was excised, and the pigment tissue appeared in some patients, even the staphyloma had formed. The topical drugs and surgery were adopted according to the severity of melting. No recurrences were found during the followup.CONCLUSION:To reduce the recurrences after the excision, the assistant treatment can be adopted. But the concentration and the duration of application should be considered, and the overdose of cauterization should be avoided to assure the enough blood supply at the wound.
KEYWORDS: pterygium; scleral melting; mitomycin C0 引言 翼状胬肉是睑裂部肥厚的球结膜组织及其下的纤维血管组织呈三角形向角膜侵入而形成的病变。当翼状胬肉伸展至角膜瞳孔区后可造成显著的视力障碍,故需及时进行手术切除。翼状胬肉可行单纯切除,但是复发率高,可达24%~89%[1]。为了减少翼状胬肉单纯切除术后的高复发率,人们采取了许多的辅助治疗,如丝裂霉素C(mitomycin C,MMC)。但是术中使用MMC可能导致巩膜溶解,从而引起严重的并发症。我们就2005/2009年所收治的7例翼状胬肉切除联合使用MMC后发生巩膜溶解患者的治疗过程分析如下。
1 对象和方法 回顾性分析2005/2009年7例患者(男4例,女3例),共7眼。患者年龄42~59(45.7±3.3)岁。该7例患者均为外院转诊来我院,术中MMC使用的浓度均为0.2g/L,作用时间1~3min。其中6例6眼行翼状胬肉切除联合MMC,1例1眼行翼状胬肉切除联合MMC联合结膜瓣转位术。所有患者于翼状胬肉术后3~47mo(27.5±17.3mo)在原翼状胬肉切除术局部发生巩膜溶解。其中2例病变较轻,仅表现为局部巩膜缺血,溶解,组织变薄,病变范围局限于角巩膜缘与内直肌止端之间,直径2~3mm未累及角膜。其余5例病变范围及程度较重,其中2例超过内直肌止端或累及角膜,3例可透见深层的色素组织,甚至形成巩膜葡萄肿。所有患者在创面均未见明显结膜及Tenon’s囊组织。所有患者既往无全身免疫性病史,无结核、梅毒等传染病史。3例患者有明显的临床症状,包括眼痛1例,畏光1例,异物感2例。其余4例无明显症状,仅在复查时发现有巩膜溶解表现。入院后行血常规、类风湿因子、血沉、免疫球蛋白、结核菌素试验、性病实验室检查、抗核抗体、肝功、肾功、胸片等全身检查。并于巩膜溶解边缘刮片行细菌、真菌病原学检查。
2 结果 入院检查,除1例患者血沉升高,达56mm/h,其余所有患者血常规、生化检查及结核、梅毒检测均未见阳性结果。病原学检查仅在1例患者中检出表皮葡萄球菌,其余患者未见病原菌。对于2例病变部位局限且未透见色素给以局部抗生素及速高捷眼膏治疗,其中1例经药物治疗后痊愈,而另外1例则需行异体角巩膜移植手术。其余患者因局部病变严重,甚至出现巩膜葡萄肿需行同种异体角巩膜移植联合结膜瓣转位手术治疗。术后继续激素、抗生素、速高捷治疗。单纯药物治疗患者在局部巩膜组织愈合,血供恢复后随访5mo。行异体角巩膜移植联合结膜瓣转位手术患者于术后随访3~7mo。所有患者在随访期间均未发生原病变区域再次巩膜溶解及血供不良等并发症,视为临床治愈。
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