【摘要】 目的：探讨丝裂霉素在不同类型原发性翼状胬肉术中局部应用的疗效。方法：选择翼状胬肉组织侵入角膜内>2mm的原发性翼状胬肉患者259例279眼，在显微镜下,按常规方法切除翼状胬肉的头颈体部，用0.2mg/mL的丝裂霉素溶液在巩膜上作用3min，生理盐水充分冲洗，缝合结膜，术后滴复方妥布霉素眼液，4次/d，涂复方妥布霉素眼膏，1次/晚，第7d拆线。随访12～18mo。结果：术后，271眼达到治愈标准，治愈率97.1%;8眼复发，复发率为2.9%。单眼单侧、双眼单侧、单眼双侧的复发率分别为1.8%，2.5%，14.3%。结论：术中局部应用丝裂霉素治疗原发性单眼单侧翼状胬肉效果良好，复发率明显降低，且未见明显副作用;而单眼双侧的翼状胬肉患者治疗后复发率仍较高。
【关键词】 丝裂霉素C;翼状胬肉;手术
Efficacy of localized mitomycin C intraoperatively to treat patients with primary pterygium
HaiJun Liu, YongDe Weng, HuiFang Yu, WeiYi Li
Department of Ophthalmology, No.421 Hospital of Chinese PLA, Guangzhou 510318, Guangdong Province, China
Correspondence to: HuiFang Yu. Department of Ophthalmology, No.421 Hospital of Chinese PLA, Guangzhou 510318, Guangdong Province, [email protected]
Received:20100702 Accepted:20100811
Abstract
AIM: To evaluate the therapeutic effect of localized mitomycin C(MMC) applied in operation for treating patients with pterygium.
METHODS: Totally of 259 patients 279 eyes with pterygium by corneal incursion more than 2mm were received 0.2mg/mL MMC on sclerae for 3 minutes after pterygium resection under microscope. Subsequently, all eyes were treated with tobramycin and dexamethasone eyedrop (qid) and tobramycin and dexamethasone ointment (qn) for 1 week postoperatively. The corneal infiltration, blood vessels and plump degree of pterygium were observed. The followup of 12 to 18 months were carried out to all of patients.
RESULTS: After operation, 271 eyes with pterygium were cured, which occupied 97.1%. Recrudescence was found in other 8 eyes with proportion of 2.9%, the patients suffered unilateral pteygium in one eye, unilateral pterygium in both eyes and bilateral pterygia in one eye were 1.8%,2.5%,14.3% respectively.
CONCLUSION: Localized MMC intraoperatively is an effective treatment for primary pterygium when it only occurred in one eye with low recrudescence and without sideeffect. However, the unilateral pterygium in both eyes or bilateral pterygia in one eye are still have high incidences to recur.
KEYWORDS: mitomycin C; pterygium; operation
Liu HJ, Weng YD, Yu HF, et al. Efficacy of localized mitomycin C intraoperatively to treat patients with primary pterygium. Int J
Ophthalmol(Guoji Yanke Zazhi) 2010;10(9):18171818
翼状胬肉是一种常见病、多发病，不但给患者带来容貌方面的困惑，同时，病程漫长，局部经常充血发炎，给患者带来许多的不适症状，影响患者的生活质量。翼状胬肉治疗以手术为主，但术后复发率高达20%～50%，仍是眼科医师较棘手的问题之一。目前，尚未见有作者对丝裂霉素治疗不同类型、翼状胬肉的复发率进行比较的报道。我们在门诊翼状胬肉切除术中局部应用MMC(0.2mg/mL)治疗不同类型的翼状胬肉患者，术后随访12～18mo，整体翼状胬肉复发率显著降低，同时显示：不同类型的翼状胬肉治疗后的复发率有明显的差异，现报告如下。
1对象和方法
1.1对象
自200001/200606，我院门诊治疗的原发性翼状胬肉患者(翼状胬肉组织侵入角膜内>2mm)259例279眼，男139例156眼，女120例123眼。单眼单侧患者218例218眼，男114例，女104例;双眼单侧患者20例40眼，男17例，女3例;单眼双侧(鼻侧和颞侧均有翼状胬肉生长)患者21例21眼，男15例，女6例。年龄32～60(平均48.5±0.5)岁。
1.2方法
制备0.2mg/mL MMC溶液，置于4℃冰箱保存(最长时间不超过1wk)备用。单眼双侧患者双侧同时治疗，双眼翼状胬肉患者相隔至少1wk后再行对侧翼状胬肉治疗。患眼表面麻醉联合局部麻醉后，在手术显微镜下，常规切除翼状胬肉头颈体部，用棉片沾湿备用的MMC溶液，去除余液，置于暴露的巩膜表面并用游离结膜遮盖(药物能作用于结膜下组织)，3min后，去除棉片，用50mL生理盐水进行充分的冲洗，缝合结膜(巩膜暴露3～4mm)，涂复方妥布霉素眼膏，纱布包扎术眼，口服消炎痛25mg，维生素C片0.2mg，维生素B1片20mg，3次/d。术后第1d开放点眼，复方妥布霉素滴眼液点术眼，4次/d，复方妥布霉素眼膏涂术眼，1次/晚。持续用药3wk，术后第5～7d拆线。
统计学分析：应用SPSS 13.0统计软件进行统计学分析，两两比较的t检验，P<0.05为有统计学意义。
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