减少翼状胬肉复发的三种术式疗效比较

Compare the effects of reducing the recurrence of pterygium in three kinds of surgeries

目的比较丝裂霉素C应用加带蒂结膜瓣转移术;羊膜移植术、自体带结膜瓣的角膜缘干细胞移植术治疗初发翼状胬肉的临床疗效,寻求一种理想的手术方法。方法将95例（110眼）患者随机分为三组,分别采用丝裂霉素C应用加带蒂结膜瓣转移术（MMC组,34眼）、羊膜移植术（AMT组,37眼）和自体带结膜瓣的角膜缘干细胞移植术（ALCT组,39眼）,术后随访一年,比较创面修复时间及复发率。结果ALCT组1眼复发,复发率为2.56%,AMT组3眼复发,复发率为8.11%,两组比较差异无统计学意义（P〉0.05）,MMC组9眼复发,复发率为26.47%,与其它两组比较差异有统计学意义（P〈0.05）。角膜创面上皮平均修复时间ALCT组为（4.73±1.15）d,AMT组（6.36±1.35）d,MMC组为（8.56±1.15）d,三组比较差异有统计学意义（P〈0.05）。结论自体带结膜瓣的角膜缘干细胞移植术治疗初发性翼状胬肉术后复发率低,角膜创面修复快,是一种理想的手术方法。

Objective To compare the therapeutic effects of primary pterygium treated by mitomycin-c combined with the transference of conjunctival flap and amniotic transplantation and autologous corneal limbal stem cell transplantation with conjunctival flap,to explore an ideal method of surgery. Method 95 cases （110 eyes） were randomly divided into mitomycin-c combined with the transference of conjunctival flap group （MMC group,34 eyes ） and amniotic transplantation group （AMT group,37 eyes） and autologous corneal limbal stem cell transplantation with conjunctival flap （ALCT group,39 eyes）. All patients had been followed for one year. Then compared the repaired time of cornea and the recurrence rate. Results One eye recurrence was noted in ALCT group,the recurrence rate was 2.56%. Three eyes recurrence were noted in AMT group,the recurrence rate was 8.11%. The differences were not statistical significant between two groups（P〉0.05）. Nine eyes recurrence were noted in MMC group,the recurrence rate was 26.47%,the differences were statistical significant comparing with other two groups（P〈 0.05）. The average repaired time of comea was 4.734 ± 1.15 days （ALCT group）,6.364 ± 1.35 days（AMT group） and 8.564 ± 1.15 days （MMC group） respectively,the diffrences were statistical significant among three groups（P〈0.05）. Conclusions autologous corneal limbal stem cell transplantation with conjunctival flap can decrease the recurrent rate,improve epithelia recovering time of coneal wound. It is an ideal method of pterygium surgery.