不同移植术治疗翼状胬肉

Transplantation with different surgeries in treatment of pyerygium

目的比较新鲜人羊膜移植、保存人羊膜移植、自体带角巩膜缘干细胞的结膜瓣移植及异体角膜缘干细胞移植联合羊膜移植治疗翼状胬肉的临床疗效。方法对196例202眼翼状胬肉患者随机组合分为A、B、C、D组。A组70眼行翼状胬肉切除联合新鲜羊膜移植术；B组75眼行翼状胬肉切除联合保存人羊膜移植术C组39眼行翼状胬肉切除联合自体带角巩膜缘干细胞的结膜瓣移植术D组18复发性翼状胬肉不适宜提供自体角膜缘而采用异体角膜缘干细胞移植联合羊膜移植术。术后随访6—12个月，对各组术后行动态观察及疗效进行回顾性分析。结果A组70眼术后复发16眼，复发率为22．86％；B组75眼术后复发17眼，复发率为22．67％；C组39眼术后复发3眼，复发率为7．69％；D组18眼术后复发5眼，复发率为27．78％；A组与B组比较（X^2=3．33，P〉0．05）：A组与C组比较（X^2=4．003，P〈0.05）；A组与D组比较（X^2=0．18，P〉0．05）；B组与C组比较（X^2=6．84，P〈0．05）；B组与D组比较（X^2=0．21，P〉0．05）；C组与D组比较（X^2=3．89，P〈0．05）；A组与C组、B组与C组、C组与D组具有显著差异性。结论自体自体带角巩膜缘干细胞的结膜瓣移植是目前治疗翼状胬肉较理想的手术方法。而异体角膜缘干细胞移植联合羊膜移植术后胬肉复发的主要原因是免疫排斥反应。

Objective To observe the therapeutic effects in treatment of pyerygium of fresh human amniotic membrane transplantation, preserved human amniotic membrane transplantation, limbal epithelial autograft with conntive-conjunctive transplantation and limbal epithelial allograft with human anmiotic membrane transplantation. Methods Two hundreds and two eyes （196 patients） were randomly divided into four groups： excision of pterygium with fresh human amniotic membrane transplantation （group A, 70 eyes）; excision of pterygium with preserved human anmiotic membrane transplantation （group B, 75 eyes）; excision of pterygium with limbal epithelial autograft with conntive-conjunctive transplantation （group C, 39 eyes）; excision of pterygium with limbal epithelial allograft with human amniotic membrane transplantation （group D, 18 eyes）. All patients had been followed up 6-12 months. Results The recurrence rate 22.86% （16 of 70 eyes were recurred） in group A; the recurrence rate 22.67% （17 of 75 eyes were recurred） in group B; the recurrence rate 7.69% （3 of 39 eyes were recurred） in group C; the recurrence rate 27.78% （5 of 18 eyes were recurred） in group D. The different being significant between the A and B group （ X^2=3.33, P〉0.05 ）; between the A and C group （X^2=4.003, P〉0.05）; between the A and D group （ X^2=0.18, P〉0.05 ）; between the B and C group （X^2=6.84, P〈0.05）; between the B and D group （ X^2=0.21, P〉0.05 ）; between the C and D group （ X^2=3.89, P〈0.05）. Conclusions Limbal epithelial autograft with conntive-conjunctive transplantation is an ideal method of pterygium surgery. However, immunology rejection is main reason of limbal epithelial allograft with human amniotic membrane transplantation.