三种不同手术方式对翼状胬肉的疗效比较

Comparison of three methods for pterygium treatment

目的比较三种不同手术方式治疗翼状胬肉的疗效。方法对210例（230眼）翼状胬肉患者随机分别采用单纯手术切除（A组，共75眼）、手术切除联合自体结膜瓣遮盖（B组，共77眼）、手术切除联合自体角膜缘干细胞移植（C组，共78眼）。术后观察角膜创面的愈合时间及翼状胬肉的复发率等情况。结果术后随访4～28（平均14．30±7．42）月。（1）复发率：A组为26．67％，B组为10．39％，C组为8．97％。A组较B、C两组的复发率显著性升高（P〈0．05），但B、C两组间的复发率差异无显著性（P〉0．05）。（2）平均角膜创面愈合时间：C组为（2．30±0．31）天，B组为（6．15±0．40）天，两者差异有极显著性（P〈0．01）。结论翼状胬肉切除联合自体结膜瓣遮盖术或联合自体角膜缘干细胞移植术均能显著降低术后复发率后者还可显著加速翼状胬肉术后角膜创面愈合时间、减轻患者的自觉症状。

Objective Compared the clinical effect of simple excision of pterygium, limbal epithelium and conjunctiva autografting combined excision and combined excision of pterygium with stem cell transplantation of corneal limbus.Methods Two hundreds and ten cases（230 eyes） were divided into three groups according to operative method, the first group（75 eyes） were treated with simple excision, the second group（77 eyes） were treated with limbal epithelium and conjunctiva autografting combined excision, the third group（78 eyes） were treated with combined excision of pterygium with stern cell transplantation of corneal limbus.Cornea healing, limbal neovascular and tissue like pterygium hyperplasia were observed.Resulst： Following up was 4-28 months（averaged 14.30± 7.42）. Recurrence rate was 26.67% in group A, 10.39% in group B and 8.97 %in group C.The recurrence of epithelium in the group A was higher than those of the other two groups, But there were no significant differences between group B and group C .The average repair time of epithelium in the group C and group B were 2.30 ± 0.31 days and 6.15± 0.40 days ,the differences were remarkable in two groups（P〈 0.05）.Conclusions Limbal epithelium and eonjunctiva autografting combined excision and combined excision of pterygium with stem cell transplantation of corneal limbus can reduce the recurrence signifieandy, the latter can lower the repair time of epithelium remarkably.