复发性翼状胬肉33眼手术疗效观察

Curative effect review of 33 eyes of recurrent pterygium surgery

目的:观察复发性翼状胬肉不同手术方法的术后再复发率及并发症。方法:我院2006-11/2009-02对31例33眼复发性翼状胬肉患者(伴有睑球粘连,眼球运动不同程度受限者12眼)施行翼状胬肉切除、丝裂霉素创面贴敷、自体结膜(带蒂或游离)移植或羊膜移植手术,手术方式:彻底切除净胬肉组织,裸露巩膜创面以0.2g/L丝裂霉素C溶液浸湿的棉片贴敷3min后,用生理盐水冲洗干净。巩膜创面覆盖方法:上或(和)下方结膜转位移植26眼,颞上方结膜游离移植2眼,羊膜移植5眼。结果:随访9mo～3a,胬肉未复发28眼;轻度复发(鼻侧球结膜及结膜下组织充血增厚,但未长入角膜缘或长入角膜缘内≤2mm)5眼,复发率15%,其中结膜转位移植4眼,羊膜移植1眼;睑球粘连轻度复发3眼;术后并发结膜肉芽肿1眼,眼部干痛、有时红卡等不适症状5眼,无1例发生角膜、巩膜溶解。结论:翼状胬肉切除联合自体结膜移植或羊膜移植及丝裂霉素创面贴敷的手术方式能明显降低复发性翼状胬肉的术后再复发率。

AIM： To observe the recurrence rate and complications of different methods of recurrent pterygium surgery. METHODS： Between November 2006 and February 2009, 31 cases （33 eyes） of recurrent pterygium （12 eyes of which were accompanied by symblepharon and limitation of ocular motility ） were treated with pterygium excision, intraoperative mitomycin C application, conjunctival autografting （pedicle or free） or amnion membrane transplantation. The surgical method was to excise pterygium thoroughly, cover the bare sclera with a sponge containing 0. 2g/L mitomycin C for 3 minutes, then irrigate the area with saline solution. The methods of covering the bare sclera included pedicle flap transposition of upper or lower conjunctiva （26 eyes） , dissociative upper and lateral conjunctiva transplantation （2 eyes）, and amnion membrane transplantation （5 eyes）.RESULTS： All cases were followed up for 9 months to 3 years with no pterygium recurrence in 28 eyes and slightly recurrence（fibrovasclar tissue did not enter the limbus of cornea or the entry size was no more than 2mm ） in 5 eyes, the recurrence rate was 15%, 4 of which had been performed with pedicle flap transposition, and 1 of which had been performed with amnion membrane transplantation. Slightly recurrences of symblepharon were observed in 3 eyes; conjunctival granuloma in 1 eye, uncomfortable symptoms such as dry, red and foreign body sensation in 5 eyes, and no corneal and sclera resolving occurrence in any eye. CONCLUSION： The surgical method of pterygium excision combined with conjunctival autograf-ting or amnion membrane transplantation, intraoperative mitomycin C application can obviously decrease the recurrence rate of recurrent pterygium.