张昊彦 黎伟波 朱伽月
【摘要】 目的 探讨四种不同手术方式治疗翼状胬肉的疗效。方法 169例(212眼)翼状胬肉患者, 根据手术方式不同分为Ⅰ组(单纯手术切除术, 23眼)、Ⅱ组(手术切除联合自体结膜移植术, 72眼)、Ⅲ组(手术切除联合自体角膜缘干细胞移植术, 81眼)、Ⅳ组[丝裂霉素(MMC)注射后联合手术切除术, 36眼]。比较四组患眼复发情况及不同胬肉分级患眼复发情况。结果 Ⅰ组复发率为39.13%, Ⅱ组复发率为11.11%, Ⅲ组复发率为4.94%, Ⅳ组复发率为13.89%。Ⅰ组复发率高于Ⅱ、Ⅲ、Ⅳ组, 差异均具有统计学意义(χ2=9.314、19.148、4.941, P<0.05)。Ⅱ、Ⅲ、Ⅳ组组间两两比较, 差异均无统计学意义(P>0.05)。Ⅰ°胬肉复发率为2.33%, Ⅱ°胬肉复发率为13.46%, Ⅲ°胬肉复发率为16.92%。Ⅰ°胬肉复发率低于Ⅱ°、Ⅲ°, 差异均具有统计学意义(χ2=4.117、5.584, P<0.05)。Ⅱ°、Ⅲ°胬肉比较, 差异无统计学意义(P>0.05)。结论 自体结膜移植术、自体角膜缘干细胞移植术及MMC注射后联合手术切除术均可以减少翼状胬肉术后复发。
【关键词】 翼状胬肉;手术切除;疗效分析
【Abstract】 Objective To discuss the efficacy of four different surgical methods for the treatment of pterygium. Methods A total of 169 cases (212 eyes) pterygium patients were divided by different surgical methods into group Ⅰ (simple surgical excision, 23 eyes), group Ⅱ (surgical excision combined with autologous conjunctival transplantation, 72 eyes), group Ⅲ (surgical excision combined with autologous limbal stem cell transplantation, 81 eyes) and group Ⅳ [surgical resection after injection of mitomycin (MMC), 36 eyes]. Comparison were made on recurrence of involved eyes in four groups and recurrence of involved eyes of different grades of pterygium. Results Group Ⅰ had recurrence rate as 39.13%, which was 11.11% in group Ⅱ, 4.94% in group Ⅲ and 13.89% in group Ⅳ. Group Ⅰ had higher recurrence rate than group Ⅱ, Ⅲ and Ⅳ, and their difference was statistically significant (χ2=9.314, 19.148, 4.941, P<0.05). Group Ⅱ, Ⅲ and Ⅳ had no statistically significant difference (P>0.05). The recurrence rate of Ⅰ° pterygium was 2.33%, which were 13.46% of Ⅱ°pterygium and 16.92% ofpterygium. The recurrence rate of Ⅰ° pterygium was lower than Ⅱ° and Ⅲ°pterygium, and the difference was statistically significant (χ2=4.117, 5.584, P<0.05). There was no statistically significant in Ⅱ° and Ⅲ°pterygium (P>0.05). Conclusion Autologous conjunctival transplantation, autologous limbal stem cell transplantation and combined operation after MMC injection can reduce the recurrence of pterygium.
【Key words】 Pterygium; Surgical resection; Efficacy analysis
翼狀胬肉(Pterygium)作为眼科的常见病、多发病, 其病理学改变主要表现为上皮下纤维血管组织增生和胶原纤维变性。其病因尚不十分明确, 但现大多认为与环境因素及过多接触紫外线照射有关。目前临床上主要的治疗方法为手术治疗, 其中主要手术方式有:单纯手术切除术、手术切除联合自体结膜移植术、手术切除联合自体角膜缘干细胞移植术、MMC注射后联合手术切除术。本研究选取在本院接受上述四种不同方式治疗的翼状胬肉患者, 分析其术后疗效及复发情况, 现报告如下。
1 资料与方法
1. 1 一般资料 选取2015年1月~2018年1月在本院治疗的翼状胬肉患者169例(212眼), 年龄43~66岁, 平均年龄(59.38±19.32)岁;男81例(103眼), 女88例(109眼), 43例(男26例, 女17例)为双眼发病, 其余为单眼发病, 均为鼻侧发病, 全部患者身体健康状况均为良好。参考胬肉分级将患眼分为Ⅰ°:即胬肉伸入角膜缘1~2 mm, 43眼;Ⅱ°:即胬肉伸入角膜缘3~4 mm, 104眼;Ⅲ°:即胬肉超过瞳孔缘, 65眼。根据患者接受的手术方式不同分成Ⅰ组(23眼)、Ⅱ组(72眼)、Ⅲ组(81眼)、Ⅳ组(36眼)。充分告知患者及家属不同术式的治疗方法及可能的复发情况, 获得患者或家属签署知情同意书。