【摘要】 目的：在同体异眼上比较翼状胬肉切除联合角膜缘干细胞滑行移植术和经典的胬肉切除联合角膜缘干细胞移植术的效果。方法：选取105例210眼初发性翼状胬肉患者，左右眼分别行胬肉切除联合角膜缘干细胞滑行移植术(A术式)和经典的胬肉切除联合角膜缘干细胞移植术(B术式)。术后随访12mo，比较双眼术后不适症状的程度及持续时间、角膜上皮愈合时间以及翼状胬肉复发情况。结果：A术式8眼翼状胬肉复发,复发率为7.8%;B术式6眼复发,复发率为5.9%,两组差异无统计学意义(P>0.05);在术后1wk，有86.7%患者诉行B术式的眼不适症状重于行 A术式的眼，术后1，2wk及1mo时，不适症状眼数A术式眼均 结论：翼状胬肉切除联合角膜缘干细胞滑行移植术与经典的胬肉切除联合角膜缘干细胞移植术相比，术后胬肉复发率无明显差异，但具有简便快捷，创伤小，修复快，术后患者自觉症状轻等优点。
【关键词】 翼状胬肉/治疗;角膜缘干细胞;眼科手术方法
Effects of two surgical techniques for excision of pterygium on different eyes of homobody
JunHua Fan, XueXi Li, DongPing Pan
Eye Center, the 180th Hospital of Chinese PLA, Quanzhou 362000,Fujian Province, China
Correspondence to: JunHua Fan. Eye Center, the 180th Hospital of Chinese PLA, Quanzhou 362000,Fujian Province, China. [email protected]
Received:20100706 Accepted:20100729
Abstract
AIM: To compare the effects of excision of pterygium with gliding the corneal limbal stem cells beside pterygiumneck(A operation) and classical pterygium excision combined with corneal limbal stem cells transplantation(B operation) on different eyes of homobody.
METHODS: There were 105 patients 210 eyes with initial pterygium in two eyes, one eye got A operation and the other got B operation. The postoperative followup period was 12 months. The duration of complaint symptoms, the time of corneal epithelium healing and recurrence of pterygium were observed after operation.
RESULTS: Eight eyes of 105 eyes that got A operation were recurred, the rate of recurred was 7.8%. 6 eyes of 105 eyes that got B operation were recurred, the rate of recurred was 5.9%. The difference was not significantly different(P>0.05). 87.6% patients complained that the eyes got B operation were more uncomfortable.The duration of complaint symptoms after operation was significantly different between two operation(P<0.01). The time of corneal epithelium healing was also significantly different(P<0.05).
CONCLUSION:The excision of pterygium with gliding the corneal limbal stem cells beside pterygiumneck is a convenient, microinjury and light compliant symptoms surgery. The rate of recurred is not significantly different between this operation and classical pterygium excision combined with corneal limbal stem cells transplantation.
KEYWORDS: pterygium/therapy; corneal stem cells; ophthalmologic surgical procedures
Fan JH, Li XX, Pan DP. Effects of two surgical techniques for excision of pterygium on different eyes of homobody. Int J Ophthalmol
(Guoji Yanke Zazhi) 2010;10(9):17881789
翼状胬肉是一种常见的眼表疾病，特别是在我国东南沿海一带发病率较高，严重影响了患者的美观与视力。经典的胬肉切除联合角膜缘干细胞移植术可以明显降低术后复发率，但手术较为复杂，且容易对干细胞供区造成损伤。为此，我们设计了一种新型的胬肉切除方式，即翼状胬肉切除联合角膜缘干细胞滑行移植术，相比单纯胬肉切除术，该手术具有简便快捷，创伤小，修复快，术后刺激症状轻，复发率低，无瘢痕等优点[1]。为进一步了解该新型手术方式与经典的胬肉切除并角膜缘干细胞移植术在术后复发率、舒适度等方面的差异，我们将两种手术方式在同体异眼上进行了临床对比，现报告如下。
1对象和方法
1.1对象
筛选200701/200807原发性双眼翼状胬肉要求手术105例210眼，男62例，女43例，年龄25～65岁。静止期160眼，进展期50眼，进展期患者术前均点地塞米松眼液和抗生素眼液1wk，6/d。术中测量所有胬肉颈部与角膜缘相连的基底宽度均<3mm。所有患者均接受双眼手术，随机选1眼归入A组，行胬肉切除并角膜缘干细胞滑行移植术，另1眼归入B组，行经典胬肉切除并角膜缘干细胞移植术。图1 胬肉切除联合角膜缘干细胞滑行移植术后6d。
1.2方法
胬肉切除联合角膜缘干细胞滑行移植术(A术式)：按我们曾经报告的方法[1]进行手术。局部结膜下麻醉后于胬肉颈部沿角膜缘弧形剪开结膜，并以角膜缘为底边，向内眦部“V”形剪除边长约4mm的三角形结膜组织。钝性分离胬肉体部后于泪阜前0.5mm处剪断胬肉，最后提起胬肉组织向角膜逆向钝性分离。以刀片刮除角膜面及巩膜面残留的胬肉组织，尽量保持角膜创面光滑平整。烧灼巩膜面止血后，沿胬肉颈部上下两侧角膜缘分离球结膜，分离时需进入透明角膜缘内约1mm，然后上下各剪开约3～5mm(具体视胬肉颈部的基底宽度决定)，之后将角膜缘两侧结膜拉合，遮盖暴露的巩膜创面，角膜缘对齐，并用100号尼龙线间断缝合固定3～4针，缝合时带少量浅层巩膜。经典翼状胬肉切除并角膜缘干细胞移植术(B术式)：按《眼表疾病的基础与临床》[2]所提供的方法手术：切除覆盖于角巩膜表面的胬肉组织，于12∶00位角膜缘处取边长约6mm带0.5mm透明角膜缘的结膜干细胞片，移植于结膜缺损区。手术完毕结膜下注射抗生素、涂氧氟沙星眼膏后术眼包扎，第2d换药并涂氧氟沙星眼膏，以后不包扎，开始滴抗生素眼液及氟美童滴眼液，6次/d，约3wk后减为4次/d，1mo后停药。术后1wk拆线。随访观察时间为术后1，2wk;1，3，6，12mo，3mo后未门诊随访的病例进行电话随访。术后观察角膜、结膜等反应情况及术后复发率。
统计学分析：所有研究数据分析采用SPSS 17.0，两样本u检验进行统计学处理。以P<0.05为有统计学意义。
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