结膜瓣遮盖用于难治性角膜溃疡的疗效和安全性研究

Efficacy and safety of conjunctival flap covering for refractory corneal ulcer

目的:研究结膜瓣遮盖用于难治性角膜溃疡的疗效和安全性。方法:选取2017年6月~2018年6月来我院就诊的120例难治性角膜溃疡病例进行临床试验,通过SPSS数据分析进行抽签分组将所有病例分成观察组(n=60)和对照组(n=60)。术前收集每位患者泪液并记录分析结果,术后与术前结果进行对比。对照组采用羊膜移植对患者进行治疗,观察组采用结膜瓣遮盖对患者进行治疗。两组患者均于治疗1个月后进行复诊,对比两组临床疗效及术后并发症发生率情况,另外对比两组治疗前后视力恢复情况及泪液指标变化[三羧酸循环(TAC)、丙二醛(MDA)、一氧化碳(NO)、谷胱甘肽过氧化物酶(GSH-Px)]。结果:观察组临床疗效总有效率83.33%与对照组临床疗效总有效率73.33%比较差异无统计学意义。术前两组视力0.05~0.3者居多,术后两组视力0.4~1.0者居多,组间对比差异无统计学意义。两组患者术前及术后三羧酸循环(TAC)、丙二醛(MDA)、一氧化碳(NO)、谷胱甘肽过氧化物酶(GSH-Px)指标数值比较差异无统计学意义;术后与术前相比观察组TAC、NO、GSH-Px数值显著增高,MDA数值显著降低,比较差异有统计学意义。两组病例均有不同程度并发症症存在,观察组并发症状总显著低于对照组28.33%,差异有统计学意义。结论:结膜瓣遮盖术用于难治性角膜溃疡能够取得显著的临床疗效,可提高患者疾病恢复速度,且该手术操作简单、安全性较高、并发症发生率低,值得临床推广。

Objective To study the efficacy and safety of conjunctival flap covering for refractory corneal ulcers.Methods 120 cases of refractory corneal ulcer in our hospital from June 2017 to June 2018 were selected for clinical trial.All cases were divided into observation group (n=60) and control group (n=60) by drawing lots through SPSS data analysis.Each patient’s tears were collected before surgery and the results were recorded.The postoperative results were compared with the preoperative results.The patients in the control group were treated with amniotic membrane transplantation,and the observation group was treated with conjunctival flaps.Both groups of patients were followed up for one month after treatment to observe the healing,vision and complications of the patients.The clinical efficacy and the incidence of postoperative complications were compared between the two groups.In addition,the visual acuity recovery and tear index changes before and after treatment were compared [TAC,malondialdehyde (MDA),carbon monoxide (NO),glutathione Glycopeptide peroxidase (GSH-Px)].Result There was no significant difference between the observation group’s total effective rate of 83.33% and the control group’s total effective rate of 73.33%.Before operation,the visual acuity of the two groups was mostly 0.05~0.3.The visual acuity of the two groups was mostly 0.4~1.0.There was no significant difference between the two groups.There were no significant differences in the values of tricarboxylic acid cycle (TAC),malondialdehyde (MDA),carbon monoxide (NO),and glutathione peroxidase (GSH-Px) between the two groups before and after surgery;The values of TAC,NO and GSH-Px in the observation group were significantly higher than those before operation,and the MDA values were significantly decreased,and the difference was statistically significant.There were different degrees of complications in the two groups.The total number of complications in the observation group was significantly lower than that in the control group (28.33%),and the difference was statistically significant.Conclusion Conjunctival flap occlusion for refractory corneal ulcer can achieve significant clinical efficacy,can improve the patient’s disease recovery rate,and the operation is simple,safe,and the incidence of complications is low,it is worthy of clinical promotion.