翼状胬肉显微手术方法的改进及其疗效观察

Improvement on microsurgical procedures for pterygium operation and observation on therapeutic effects

目的比较两种不同显微手术操作方法治疗翼状胬肉对角膜创面愈合时间及胬肉复发率的影响。方法对120例（120眼）翼状胬肉患者随机分别采用常规显微手术方法60例（60眼）和改进的显微手术方法60例（60眼）切除翼状胬肉。改进的显微手术方法是根据胬肉头部与角膜的病理结构关系特点，在剥离时做到有的放矢，从而达到在切尽翼状胬肉组织的同时尽量减少对术眼创伤的效果。术后1％荧光素钠染色，裂隙灯下观察角膜创面的愈合情况，随访时间均在一年半以上，平均随访20．5个月。结果平均角膜创面愈合时间，常规显微手术组为（5．65±0．20）d；改进显微手术组为（2．20±0．11）d，两者差异有统计学意义（t=14．16，P〈0．01）。翼状胬肉复发例数，常规显微手术组为9例（9／60），复发率为15％；改进显微手术组为3例（3／60），复发率为5％，两者差异也有统计学意义（x^2=1．25，P〈0．05）。结论改进的显微手术操作方法能够显著加速翼状胬肉术后角膜创面愈合时间、降低术后复发率。

Objective To compare the effects on epithelial recovering of corneal wound and recurrent rate of different mierosurgical procedures for pterygium. Methods 120cases （ 120 eyes） of primary pterygium were excised under microscope with routine microsurgical procedure（ sixty eyes of sixty cases）and improved microsurgical procedure（ sixty eyes of sixty cases）. Improved microsurgical procedure was on the basis of pathological relationship between pterygium head and Cornea. Pterygium was dissected thoroughly, corneal wound was reduced possibly at the same time. Post-op eyes were dyed with 1% Fluorescein Sodium, recovering of corneal wound was observed under slit lamp. All eases were followed up above 18 months （ averaged 20.5 months）. Results The average epithelial recovering times of corneal wound were （5.65 ± 0.20） days in routine mierosurgi- cal procedure group, （ 2.20 ± 0. 11 ） days in improved microsurgical procedure group, respectively. The differences were significant between two groups （ t = 14. 16, P 〈 0. 01 ）. There were 9 eyes （ 15% ） and 3 eyes （ 5% ） that recurred after the operation in two groups,the differences were also significant（x^2 = 1.25 ,P 〈0.05）. Conclusion The improved microsurgieal procedure for pterygium can significantly improve epithelial recovering of corneal wound, promote the therapeutic effect and decrease the rate of recurrence.