【摘要】 目的：观察手术放大镜下行翼状胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉的临床疗效。方法：对102例104眼原发性翼状胬肉患者在手术放大镜下行翼状胬肉切除联合自体角膜缘干细胞移植，观察术后复发情况。结果：术后随访3～12mo，6眼复发，复发率为5.8%。结论：手术放大镜下行翼状胬肉切除联合自体角膜缘干细胞移植治疗原发性翼状胬肉，能有效降低胬肉术后复发率，是目前医疗条件下值得推广的手术方法。
【关键词】 手术放大镜;原发性翼状胬肉;角膜缘干细胞;移植术
Clinical analysis of pterygium excision combined with autologous limbal stem cell transplantation under microscope
LüXia Yan, JinYun Yan
Department of Ophthalmology, the First Peoples Hospital of Xiantao, Xiantao 433000, Hubei Province, China
Correspondence to: LüXia Yan. Department of Ophthalmology, the First Peoples Hospital of Xiantao, Xiantao 433000, Hubei Province, China. [email protected]
Received:20100719 Accepted:20100811
Abstract
AIM: To observe clinical effect of pterygium excision combined with autologous limbal stem cell transplantation under microscope.
METHODS: Totally 102 patients 104 eyes with primary pterygium underwent pterygium excision combined with autologous limbal stem cell transplantation by microscope and the postoperative recurrence rate was observed.
RESULTS: All patients were followed up from 3 to 12 months. 6 cases recurred after surgery, and the recurrence rate was 5.8%.
CONCLUSION: Pterygium excision combined with autologous limbal stem cell transplantation under microscope can reduce the recurrence rate of primary pterygium,and is a surgical method worth extending in primary hospital.
KEYWORDS:surgical microscope; primary pterygium; corneal limbal stem cells; transplantation
Yan LX, Yan JY. Clinical analysis of pterygium excision combined with autologous limbal stem cell transplantation under microscope. Int
J Ophthalmol (Guoji Yanke Zazhi) 2010;10(9):18211822
翼状胬肉是眼科的常见病和多发病,治疗方法以手术为主,按常规方法治疗，复发率仍很高,国内报道20%～70%,国外报道24%～89%[1],随着显微手术的发展，手术方法的改进以及抗结缔组织增殖药物的应用，使该手术的复发率日渐降低。我院自200703/200903在门诊使用手术放大镜下行胬肉切除联合自体角膜缘干细胞移植术治疗原发性翼状胬肉102例104眼，收到明显效果，现报告如下。
1对象和方法
1.1对象
选取200703/200903来我院门诊眼科就诊的102例104眼原发性翼状胬肉患者,头部侵入角膜缘2～8mm不伴有其他眼表疾病的患者。年龄35～68岁，其中男46例48眼;女56例56眼。单眼100例，双眼2例。术眼滴用典必殊眼药水+阿昔洛韦眼药水3～5d，4～6次/d直至胬肉无充血。术前行血常规、空腹血糖检查，测血压。
1.2方法
术前患眼滴爱尔凯因2次，术者头戴手术放大镜。常规消毒铺巾,开睑后,20g/L利多卡因局部麻醉。用显微有齿镊轻轻提起胬肉头部,用15°穿刺刀刀尖划破角膜上皮层,自角膜分离胬肉,掀起一胬肉瓣夹住头部胬肉,顺势将胬肉头部自角膜撕离，动作轻柔,再钝性分离胬肉与巩膜直至内直肌止端,然后用弯剪刀将被覆在胬肉表面的球结膜和胬肉体部分离至泪阜部，将胬肉自根部剪除，刮除干净角巩膜残留的胬肉组织,充分止血,剪除胬肉头部的结膜，使角膜缘外暴露2～3mm裸露区。在同一眼上方切取相应大小和形状的带角膜缘干细胞的游离球结膜植片,平铺于胬肉切除后的巩膜表面,上皮面朝上,植片角膜缘与受区角膜缘对合。100尼龙线将移植片其余三边与结膜创缘对应缝合。缝合时将移植片的四角固定缝合于浅层巩膜上。使移植片完全平铺于植床上，遮盖整个巩膜裸露区，供区不予处理。术毕，用庆大霉素+地塞米松冲洗结膜囊,涂妥布霉素+地塞米松眼膏，加压包扎术眼。术后处理:术后第1d换药滴用妥布霉素+地塞米松眼液,贝复舒眼液,4次/d,睡前涂用妥布霉素+地塞米松眼膏。术后第3d涂眼膏开始热敷,3次/d,每次15min,如角膜缺损面较大,须加用贝复舒凝胶。10d拆线。拆线后继续滴用抗菌素+激素眼药水直至痊愈。
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