1999至2009年温州地区角膜移植手术的临床分析

Clinical analysis of keratoplasty in the Wenzhou area from 1999 to 2009

目的分析1999年9月至2009年12月在浙江省温州医学院附属眼视光医院施行角膜移植手术病例的病因以及手术方式的变化趋势。方法调查研究。统计1999年9月至2009年12月在眼视光医院施行角膜移植手术患者的病因，并记录患者的年龄、性别、籍贯、诊断、手术方式等相关信息．把上述信息输入Excel表格中，进行描述性分析，计算百分比，结果用各种统计图表来表示。结果这10年间行角膜移植手术患者的年龄分布呈正态性，平均为44．4岁，高峰在50～59岁。男性患者多于女性患者，男性患者在细菌性角膜病变和外伤中所占的百分比明显高于女性。近2／3患者来源于温州地区。共对651例患者（727眼）施行了角膜移植手术，其中439例（495眼）行穿透性角膜移植术。103例（123眼）行深板层角膜移植术．62例（62眼）行板层角膜移植术，40例（40眼）行穿透性角膜移植联合白内障摘除手术，7例（7眼）行其他类型角膜移植手术。最常见的病因为感染性角膜病变，168眼（23．1％），其中细菌性角膜溃疡86眼（11．8％），真菌性角膜溃疡82眼（1113％）。其他的有单纯疱疹病毒性角膜炎165眼（22．7％），角膜白斑（包括先天性白斑以及感染愈合后遗留的白斑）95眼（13．1％），外伤（包括化学伤、热烧伤、爆炸伤以及外伤后角膜疤痕）64眼（8．8％），圆锥角膜58眼（8．0％），大泡性角膜病变（人]_晶状体眼或无晶状体眼）57眼（7．8％），角结膜皮样瘤（包括Goldenharr综合征）43眼（5．9％）以及各种类型角膜营养不良和变性4l眼（5．6％），24眼（3.3％）为再次移植。穿透性角膜移植手术量从2005年后有逐渐下降趋势．而板层和深板层角膜移植手术量有逐渐增加趋势。结论感染性角膜病变是温州地区角膜移植最常见的病因．单纯疱疹病毒性角膜炎是单病种中最多见的病因。本次研究结果和中国北部地区结果相似，和欧美国家结果有所不同。对于内皮功能正常的患者，深板层角膜移植术将逐渐取代穿透性角膜移植术。

Objective To analyze the indications for keratoplasty at Eye Hospital of Wenzhou Medical College, Zhejiang province, from September 1999 to December 2009 and the trend of surgical procedures. Methods The investigation involved an analysis of the indications for these patients, and age, gender, place of residence, diagnosis, surgical procedure, etc., were recorded. All the information was input into an Excel format for descriptive analysis. Results were illustrated with graphs and format. Results During the approximate ten-year span, patient age distribution was bimodal, the average age was 44.4 years with peaks in the 6^th decade. There were more male than female patients. There was a higher percentage of male patients with bacterial keratitis and trauma than for women. Nearly two-thirds of the patients were from the Wenzhou area. There were 651 cases （727 eyes） underwent corneal surgery in our study. This included 439 cases （495 eyes） of penetrating keratoplasty, 103 cases （123 eyes）of deep lamellar keratoplasty, 62 cases （62 eyes）of lamellar keratoplasty, 40 cases （40 eyes） of keratoplasty combined with cataract surgery and 7 cases （7 eyes） with other types of keratoplasty. The leading indications for keratoplasty were infectious keratitis （168, 23.1%）, including bacterial keratitis （86, 11.8%） and fungal keratitis （82, 11.3%）. This was followed by herpes simplex keratitis （165, 22.7%） and corneal scarring （95, 13.1%）,including congenital corneal scan＇ing and scarring frmn infection, trauma （64, 8.8%）. including chemical lmrn, tllermal burn and explosion injury, keratoconus （58, 8.0%）, bullous keratopathy （pseudopbakic or apbakic） （57, 7.8%） , enrnea] dermoid （ including Gohtenharr syndrome ） （43 , 5.9%）, corneal dystrophy and degeneration （41, 5.6%） and regrafting （24, 3.3%）. The number of penetrating keratoplasty cases has gradually declined since 2005 and lamellar and deep lamellar keratoplasty cases have shown a gradually increasing trend. Conclusion In our study, infectious keratitis was the leading indicator for keratoplasty at Wenzbou area. Herpes simplex keratitis was the leading indieator for a single disease. This was similar to northern China, but different from European and American countries. For patients with normal endothelial function, deep lamellar keratoplasty will gradually replace penetrating keratoplasty as the leading surgery.