【摘要】 目的：探讨丝裂霉素C联合自体角膜缘干细胞移植治疗复发性翼状胬肉的疗效。方法：将69例87眼复发性翼状胬肉随机分成两组，治疗组：35例45眼行翼状胬肉切除后联合丝裂霉素C及自体角膜缘干细胞移植。对照组：34例42眼行翼状胬肉切除后联合自体角膜缘干细胞移植。结果：术后随访观察了3～12mo。治疗组治愈44眼，治愈率98%，复发1眼，复发率2%;对照组治愈36眼，治愈率86%，复发6眼，复发率14%，两组复发率有统计学意义(χ2 =4.273，P=0.039)。结论：丝裂霉素C联合自体角膜缘干细胞移植明显提高治愈率，降低复发率，临床中值得推广。
【关键词】 翼状胬肉;角膜缘干细胞;丝裂霉素C;复发
Analysis of the effect on mitomycin C combined with autologous limbal stem cell in treatment of recurrent pterygium
YuLing Wei
Department of Ophthalmology, the Fourth Peoples Hospital of Liuzhou, Liuzhou 545001, Guangxi Zhuang Autonomous Region, China
Correspondence to: YuLing Wei. Department of Ophthalmology, the Fourth Peoples Hospital of Liuzhou, Liuzhou 545001, Guangxi Zhuang Autonomous Region, China. [email protected]
Received:20100628 Accepted:20100803
Abstract
AIM: To explore the outcome of mitomycin C combined with autologous limbal stem cell transplantation for treatment of recurrent pterygium.
METHODS: Totally 69 cases 87 eyes with recurrent pterygium were randomly divided into two groups. The treatment group: 35 cases 45 eyes after pterygium excision were treated with mitomycin C combined with autologous limbal stem cell transplantation. The control group: 34 cases 42 eyes after pterygium excision were treated with autologous limbal stem cell transplantation.
RESULTS: During a followup of 3 to 12 months, in the treatment group 44 eyes were cured and the cure rate was 98%; with 1 eye of recurrence, the recurrence rate was 2%; in the control group, 36 eyes were cured and the cure rate was 86%; with 6 eyes of recurrence, the recurrence rate was 14%. Recurrence rate of the two groups was statistically significant (χ2 = 4.273, P=0.039).
CONCLUSION: Mitomycin C combined with autologous limbal stem cell transplantation significantly increases the cure rate and reduces the recurrent rate, worthy of promotion in clinical therapy.
KEYWORDS: pterygium; limbal stem cell; mitomycin C; recurrence
Wei YL. Analysis of the effect on mitomycin C combined with autologous limbal stem cell in treatment of recurrent pterygium. Int J
Ophthalmol(Guoji Yanke Zazhi) 2010;10(9):18111812
翼状胬肉是一种常见病，流行病学调查认为紫外线与翼状胬肉的发病有关，其临床特点为新生的纤维血管组织自球结膜生长侵入角膜[1]。其治疗方法有药物、烧灼、冷冻、激光、超声波等。但效果均不理想，因此，手术治疗仍是目前最常用的方法，但术后复发率高。我们选用丝裂霉素C联合自体角膜缘干细胞移植与自体角膜缘干细胞移植比较，观察其术后复发率，现报告如下。
1对象和方法
1.1对象
选择200503/200903在我院眼科就诊的复发性翼状胬肉患者69例87眼。其中，男36例40眼，女33例47眼，年龄30～65(平均48.5)岁。所有病例胬肉全部位于鼻侧，胬肉头部侵入角膜缘内2～3mm以上。74眼为第1次术后复发，13眼为第2次术后复发。所有病例的第1，2次手术均在无显微手术条件的县级医院或乡镇卫生院完成。
1.2方法
治疗组：手术显微镜下进行，20g/L利多卡因注入胬肉体部结膜下，距角膜缘2mm处剪开球结膜，钝性分离球结膜与胬肉组织至半月前皱襞外约1mm，宝石刀分离长入角膜的部分并钝性分离至前弹力层，剪除分离的胬肉及变性组织，充分刮净角膜表面的胬肉组织及角膜缘的变性血管，并沿角膜缘弧形切开1/3层角膜缘深度，巩膜面留下约3mm×4mm裸露区，烧灼止血后，将浸有0.2g/L丝裂霉素C的棉片覆盖在暴露的巩膜上，且距角膜缘约2mm，宽度超出胬肉体部1mm，3～5min后用生理盐水反复冲洗干净，于同侧眼颞上方取达透明角膜组织内0.5mm，深及前弹力层，且带2～3mm球结膜组织的角膜缘板层植片，大小视胬肉切除情况而定，100显微缝线带浅层巩膜间断缝合固定植片，并将植片球结膜与创面球结膜连续缝合，覆盖巩膜创面。对照组：胬肉切除后，其自体角膜缘干细胞移植方法与治疗组相同。两组角膜缘取材处均无需处理。术后处理与随访：术后结膜下消炎抗菌处理，结膜囊内涂典必殊眼膏，术后1d滴抗生素及皮质类固醇激素眼液，7d拆线。术后1，3，5，7，10d;1，3，6，12mo复查。
统计学分析：采用SPSS 13.00统计软件分析，组间比较用χ2检验，以P<0.05为有统计学意义。
[1] [2] 下一页 |
