不同手术方式翼状胬肉切除术后巩膜并发症的临床研究

Clinical analysis of scleral complications after different pterygium surgery

目的:分析不同术式翼状胬肉切除术后巩膜并发症的临床表现、原因及治疗愈后。方法:回顾性研究原发性翼状胬肉患者577例857眼,根据术式的不同分为4组,分析各组术后巩膜并发症的临床表现,可能原因及治疗效果。结果:共有39眼出现不同程度巩膜并发症,单纯翼状胬肉切除术联合使用丝裂霉素组术后出现刺激症状及巩膜并发症者明显高于其他组,其次为单纯翼状胬肉切除术组(P<0.01),停用皮质类固醇激素药物后34眼予以羟丙甲基纤维素眼液、贝复舒眼液等点眼1～2wk后巩膜创面逐渐愈合。5眼巩膜坏死者予以局部清创后新鲜羊膜遮盖缝合后逐渐愈合。结论:巩膜并发症的术前预防、早期发现、早期治疗至关重要,术前慎重选择手术方式、术后规范用药可有效减少胬肉术后巩膜并发症的发生。

AIM：To analyze the clinical manifestations, causes and treatment of scleral complications after different pterygium surgery. METHODS：By retrospective study, the 577 cases （857 eyes） with primary pterygium were divided into 4 groups according to different surgical procedures. The clinical manifestations, causes and treatment were observed. RESULTS：A total of 39 eyes appeared different degree scleral complications. There were more stimulating symptoms and scleral complications in the group Ⅱof pterygium resection combined with mitomycin than those in other groups （P0.01）, followed by group Ⅰof pterygium resection. 34 eyes were cured after eyedrops of hydroxymethyl propyl and Basic Fibroblast Growth Factor（BFGF） in about 2 weeks. 5 eyes with scleral necrosis were gradually healing after the debridement and fresh amniotic membrane transplantation. CONCLUSION：Early detection and effective treatment, preoperative prevention are very important in the scleral complications,correct pterygium surgery and eyedrops can effectively reduce scleral complications.