翼状胬肉根治手术预防结膜复发的效果观察

Effect of radical pterygium excision for preventing conjunctival recurrence

目的探讨不同翼状胬肉切除手术预防结膜复发的效果。方法根据手术方式的不同,将本院接受翼状胬肉切除手术的原发性翼状胬肉患者206例（263眼）分为A、B2组,A组92例（120眼）接受翼状胬肉根治切除手术,即翼状胬肉切除和结膜瓣转移移植术联合球筋膜广泛切除和翼状胬肉残留的球结膜尽量切除术;B组114例（143眼）仅接受翼状胬肉切除和结膜瓣转移移植术。术后随访3~69个月,平均18.6个月,裂隙灯显微镜检查角膜、结膜及巩膜创面情况,比较2组翼状胬肉患者术后结膜复发的眼数和发生率。结果A组巩膜创面主要由转移结膜瓣覆盖,水肿、充血轻,其中16眼结膜复发,发生率为13.33%;B组巩膜创面主要由翼状胬肉残留的球结膜覆盖,充血持续1个月以上,其中66眼结膜复发,发生率为46.15%;用χ2检验分析,2组结膜复发发生率差异有显著统计学意义（χ2=32.75,P〈0.005）。结论翼状胬肉根治切除手术预防结膜复发的效果显著。

Objective To investigate the clinical efficacy of different pterygium excision for preventing conjunctival recurrence.Methods According to the methods of pterygium excision,206 patients（263 eyes）with primary pterygium had been divided into two groups：group A and group B.All patients had received pterygium excision,92 patients（120 eyes）in group A were taken radical pterygium excision,namely,pterygium excision and conjunctival rotation autograft combined with extensive fascia removal and the residual bulbar conjunctiva removal to the limit.About 114 patients（143 eyes）in group B had only received pterygium excision and conjunctival rotation autograft.All patients of the two groups had been followed up for 3 to 69 months with an average of 18.6 months.Conditions of retinal,conjunctival and scleral wound surfaces were observed under slit-lamp microscope.Eyes and incidence rate of conjunctival recurrence were compared between the two groups postoperatively.Results The scleral wound surfaces were mainly covered by transferred conjunctival flap,were with hyperemia and slight edema in group A.The scleral wound surfaces were mainly covered by residual bulbar conjunctiva of pterygium,and hyperemia was kept for more than 1 month.There were 16 eyes were found with conjunctival recurrence in group A and 66 eyes in group B.The incidence rates of conjunctival recurrence were 13.33% and 46.15%,respectively.There was statistical difference in incidence rate of conjunctival recurrence between the two groups with chi square test（χ2=32.75,P0.005）.Conclusion Radical pterygium excision is significantly effective for conjunctival recurrence.