【摘要】 目的:观察带蒂结膜瓣移植联合丝裂霉素C治疗翼状胬肉的临床效果，探寻减少复发的最佳术式。方法：对131例131眼行翼状胬肉切除术、联合丝裂霉素C湿贴、带蒂结膜瓣移植术，术后点重组牛碱性成纤维细胞生长因子及氧氟沙星滴眼液。结果：患者术后随访观察6mo～2a，131例131眼有4眼复发，复发率为3.1%。结论：带蒂结膜瓣移植联合应用丝裂霉素C湿贴治疗翼状胬肉，复发率较低，手术简单易行，费用低，不失为一种好办法，尤其针对基层医院比较适合。
【关键词】 带蒂结膜瓣;移植;丝裂霉素C;翼状胬肉
Therapeutic efficacy of pedicle conjunctival transplantation and MMC for pterygium
ShaoJun Li
Department of Ophthalmology, Maternal and Child Care Center of Tongzhou District, Beijing 101100,China
Correspondence to: ShaoJun Li. Department of Ophthalmology, Maternal and Child Care Center of Tongzhou District, Beijing 101100, [email protected]
Received:20100720 Accepted:20100806
Abstract
AIM: To observe the therapeutic efficacy of pedicle conjunctival transplantation and mitomycin C (MMC) for pterygium, and explore the optimal surgery with minimum recurrence ratio.
METHODS: Totally 131 cases 131 eyes underwent the excision of pterygium, pedicle conjunctival transplantation and MMC, and recombination calf fibroblast growth factor and ofloxacin were applied.
RESULTS: In the followup of 6 months to 2 years, 4 eyes recurred in all 131 patients 131 eyes, and recurrence ratio was 3.1%.
CONCLUSION: The pedicle conjunctival transplantation and MMC surgery have the lower recurrence ratio, the simpler operation protocol, and the cheaper cost,which is suitable for the primary hospital and is a suitable way for pterygium.
KEYWORDS: pedicle conjunctival flap; transplantation; mitomycin C; pterygium
Li SJ. Therapeutic efficacy of pedicle conjunctival transplantation and MMC for pterygium. Int J Ophthalmol(Guoji Yanke Zazhi) 2010;10(9):18131814
翼状胬肉是眼科常见的一种以纤维血管组织慢性增生为特征的慢性眼表疾病，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]。到目前为止，翼状胬肉的病因及发病机制仍不十分明确。翼状胬肉的主要治疗方法是手术。我们采取带蒂结膜瓣移植联合应用丝裂霉素治疗翼状胬肉，现报告如下。
1对象和方法
1.1对象
我科200101/200912门诊与住院翼状胬肉患者131例131眼，男73眼，女58眼，年龄30～78(平均57.8)岁。职业：农民86例，工人45例。
1.2方法
患者131例131眼在显微镜下，于胬肉头部前0.5mm作角膜浅层剥离，完全分离至泪阜处，泪阜前将胬肉完全切除，清除角巩膜表面残留组织，灼热止血。随后用稀释至0.25g/L丝裂霉素C的棉片置于裸露的巩膜表面3min，再用生理盐水反复冲洗巩膜表面。然后自球结膜创面下方，沿角膜缘剪开球结膜，做一带蒂结膜瓣，结膜瓣大小应根据切除胬肉情况而定，辨别结膜正反面后，再将结膜瓣旋转覆盖在裸露的巩膜表面，用100尼龙线连续缝合固定结膜瓣。术毕用抗生素眼膏涂结膜囊，敷料遮盖。术后处理：术后绷带包扎2d，每天换药，术后7d拆线，用典必殊眼药水点眼， 4次/d，持续4wk后改抗生素点眼。随访6mo～2a。
2结果
所有患者在1wk内有轻度刺激症状，上下方取材处结膜伤口6d内被新生上皮覆盖，无瘢痕形成。131眼有4眼(3.1%)复发，患者未发生丝裂霉素C造成的严重并发症。
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