【摘要】 目的：观察自体角膜缘干细胞移植术治疗复发性翼状胬肉疗效。方法:把66例81眼复发性翼状胬肉患者随机分为两组，治疗组：34例44眼行翼状胬肉切除联合自体角膜缘干细胞移植术;对照组：32例37眼行翼状胬肉切除联合带蒂结膜瓣转移术。胬肉复发的定义：血管纤维组织重新侵入角膜。结果：术后随访 12～24mo。治疗组治愈率98% ,复发率2% ;对照组治愈率84% ,复发率16%。两组复发率有统计学意义(χ 2=4.62, P<0.05) ,两组均无明显并发症。结论：自体角膜缘干细胞移植术治疗复发性翼状胬肉疗效高，复发率低于带蒂结膜瓣转移术。
【关键词】 翼状胬肉;角膜缘干细胞;移植
Limbal conjunctival autograft transplantation for recurrent pterygium
MeiXian Cheng, TianChang Luo, MinYi Ruan
Department of Ophthalmology, the Affiliated Zhangzhou Municipal Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province,China
Abstract AIM:To investigate the efficiency of limbal conjunctival autografting technique in recurrent pterygium. METHODS: Fortyfour eyes of 34 patients with recurrent pterygium were treated by limbal conjunctival autografting technique and 37 eyes of 32 patients with recurrent pterygium were treated by transplantation of conjunctival pedicle flap. Recurrence was defined as fibrovascular tissue crossing the corneoscleral limbus onto clear cornea in the area of previous pterygium excision. RESULTS: The followup periods ranged from 12 to 24 months. All 66 patients (81 eyes) were involved in the result analysis .In the therapeutic group, the cure rate was 98% and the recurrence rate was 2%, but in the control group the cure rate was 84% and the recurrence rate was 16%.There was a statistically significant difference in the recurrence rate between the patients who underwent limbal conjunctival autografting and those who underwent transplantation of conjunctival pedicle flap (χ2=4.62,P<0.05). In addition, no significant complications were noted. CONCLUSION: Limbal conjunctival autografting is an effective surgical technique for the treatment of recurrent pterygium. It has a low recurrence rate when compared with the transplantation of conjunctival pedicle flap technique.
KEYWORDS: pterygium; stem cell of limbal cornea;transplantation
0 引言
翼状胬肉是眼科常见的角结膜病。翼状胬肉的治疗至今仍以手术为主。翼状胬肉的手术方法很多，但至今仍没有一种方法能完全防止复发。复发性翼状胬肉手术更复杂，术后更容易复发。我们选用翼状胬肉切除联合自体角膜缘干细胞移植治疗复发翼状胬肉并与自体结膜瓣转位移植比较，观察其术后复发率及并发症。现将结果报告如下。
1 对象和方法
1.1 对象
选择200506/200901在我院眼科手术而且资料完整的复发性翼状胬肉患者66例81眼 ,男35例43眼,女31例38眼。年龄23～66(平均49.2)岁。66眼均为外院手术后的复发性翼状胬肉，其中21眼为第2次术后复发，7眼为第3次术后复发，17眼伴睑球粘连。随机把患者分为两组，A组：翼状胬肉切除联合自体角膜缘干细胞移植34例44眼;B组：翼状胬肉切除联合带蒂结膜瓣转移32例37眼。慢性泪囊炎，全身性疾病不宜手术者除外。
1.2 方法
翼状胬肉切除联合自体角膜缘干细胞移植术，胬肉切除先从颈部剪开结膜，并沿结膜下向体部分离至泪阜部，分离结膜时尽量不保留结膜下组织。用剃须刀片从翼状胬肉头部开始剖切直到角膜缘，深度达前弹力层，把胬肉与巩膜上组织钝性分离，再把胬肉头颈部及体部切除。胬肉切除后取上方靠近角膜缘结膜瓣，大小与巩膜暴露区一样或略大，所做的结膜瓣应包括角膜缘结膜但不带结膜下组织。把结膜瓣置于胬肉切除处，结膜瓣的角膜缘对准胬肉切除处角膜缘，用80尼龙线把结膜瓣4个角缝合固定于浅层巩膜，其余结膜瓣与结膜切缘用80尼龙线间断缝合，上方取结膜处不做处理。翼状胬肉切除联合带蒂结膜瓣转移，常规翼状胬肉切除后沿角膜缘向上延长结膜切口，再从切口上端做一与角膜缘垂直切口，然后向鼻上分离做一不带结膜下组织的结膜瓣，所做的结膜瓣大小依缺损面积大小而定。用 80可吸收尼龙线把结膜瓣与下方及鼻侧结膜切缘分别间断缝合 2～3针 ,近角膜缘处把结膜瓣缝合于浅层巩膜上。手术由同一个医生在手术显微镜下进行。术后处理：术后每天换药，常规裂隙灯检查及视力检查，观察角膜上皮、角膜透明情况及结膜瓣愈合情况。术后第1d点抗生素、皮质类固醇眼液,6～8次/d,1wk拆线后每天点抗生素、皮质类固醇眼液 4次 ,持续 3～4wk。术后第3wk测眼压 ,若眼压高停用皮质类固醇眼液。随访观察 12～24(平均15.6)mo。疗效判断：治愈：移植片平复无增厚，无新生血管及胬肉增生。复发：局部结膜增生肥厚，新生血管纤维膜侵入角膜。
统计学分析：采用χ2检验，以P<0.05为有统计学意义。
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