翼状胬肉切除联合羊膜移植术及术中应用丝裂霉素C对结膜上皮细胞的影响

Influence of pterygium excision and amnio-tic membrane transplantation combined with mitomycin C application on conjunctival epithelial cells

目的观察翼状胬肉切除联合羊膜移植术及术中应用丝裂霉素C(mitomycin C,MMC)对患者结膜上皮细胞的影响。方法将42例(71眼)翼状胬肉患者随机分为翼状胬肉切除联合羊膜移植术组(A组)和翼状胬肉切除联合羊膜移植及术中应用MMC组(B组),分别于术前、术后不同时间应用硝酸纤维素薄膜滤纸取2组患者眼表结膜上皮组织,结膜印迹细胞学对杯状细胞、炎症细胞等进行定性检查,流式细胞仪对细胞凋亡率进行定量检查。结果翼状胬肉区结膜上皮细胞鳞状化生明显(100%),细胞变长,核/浆比减少,杯状细胞较多;术后30 d、90 d结膜上皮细胞形态规整、小而密集、含大量杯状细胞。2组术后非胬肉区结膜杯状细胞数量较术前均显著增加(P均<0.05),2组术前、术后各观察阶段比较,差异有统计学意义(A组:F=4.48,P=0.02;B组:F=3.47,P=0.04);术后1～14 d炎症细胞明显。2组患者术前非胬肉区球结膜上皮细胞凋亡率A组平均9.52%±4.42%,B组平均9.66%±3.91%,与正常(6.75%±1.29%)相比偏高,但差异均无统计学意义(P均>0.05);2组术前、术后各观察阶段比较,差异均有显著统计学意义(A组:F=5.21,P=0.001;B组:F=4.53,P=0.003),其中A组术后7d、14 d与其他观察阶段相比差异有统计学意义(P<0.05),B组术后14 d与其他观察阶段相比差异有统计学意义(P<0.05)。结论翼状胬肉切除联合羊膜移植术中局部应用MMC能有效促进创面愈合、改善眼表,且毒副作用小,是安全、有效的手术方法。

Objective To investigate the influence of pterygium excision and amniotic membrane transplantation combined with mitomycin C（MMC） application on conjunctival epithelial cells of pterygium patients.Methods Forty-two pterygium patients（71 eyes） were randomly divided into group A（pterygium excision and amniotic membrane transplantation） and group B（pterygium excision and amniotic membrane transplantation combined with MMC application）.Conjunctival epithelial cells of patients in both two groups were collected with nitrocellulose filter preoperatively and at different postoperative times.Conjunctival impression cytology was used to qualitatively detect goblet cells and inflammatory cells;Flow cytometer was used to quantitatively measure cell apoptotic rate.Results The conjunctival epithelial cells demonstrated obvious squamous metaplasia at pterygium region（100%）.Cells became longer,the ratio of nucleus to kytoplasm decreased and goblet cells increased.At postoperative 30 days and 90 daysconjunctival epithelial cells were with complete morphology,small and intensive,and there were lots of goblet cells.The number of goblet cells at non-pterygium region obviously increased postoperatively compared with that preoperatively in both two groups（both P〈0.05）.There was significant difference between pre-operation and post-operation in two group（group A：F=4.48,P=0.02;group B：F=3.47,P=0.04）;There were lots of inflammatory cells at postoperative 1 day to 14 days.The average apoptotic rates of conjunctival epithelial cells at non-pterygium region were 9.52%±4.42% in group A and 9.66%±3.91% in group B postoperatively,and both were higher than normal value 6.75%±1.29%（both P〉0.05）;There was significant difference between pre-operation and post-operation in two group（group A：F=5.21,P=0.001;group B：F=4.53,P=0.003）.Significant difference was found at postoperative 7 days or 14 days compared with other time point in group A,and at postoperative 14 days compared with other time point in group B（all P〈0.05）.Conclusion Pterygium excision and amniotic membrane transplantation combined with local application of MMC is a safe and effective method to promote the healing of wound surface,improve ocular surface and be with little side effects.