翼状胬肉切除联合带蒂结膜瓣移植术对泪液功能的影响

Influence of pterygium excision with autologous conjunctiva-flap transplantation on tear function in patients with pterygium

目的:评价翼状胬肉切除联合带蒂结膜瓣移植术对翼状胬肉患者泪液功能的影响情况。方法:对入选的翼状胬肉患者行胬肉切除联合带蒂结膜瓣移植手术,在术前1d;术后3,7d;术后1mo做泪膜破裂时间(BUT)、泪液分泌(SchirmerⅠ)试验和泪液羊齿状试验(TFT),在术前1d和术后1mo做结膜印迹细胞学检查,以评价患者术前、术后的泪液功能。结果:共纳入87例87眼患者,其中男45例,女42例。年龄45～81(平均64.1±8.8)岁。术后1moBUT较术前1d延长,分别为11.47±3.23s和9.43±3.25s(P<0.05);术前羊齿状试验结果正常(Ⅰ级和Ⅱ级)的患者占22%,术后1mo正常的患者增加至90%,术后1moTFT较术前明显改善(P<0.05);术后杯状细胞密度要高于术前结膜杯状细胞密度,分别为39.73±18.46个/10个高倍镜和48.85±18.80/10个高倍镜(P<0.05)。泪液分泌Ⅰ试验结果显示术后早期分泌较术前增多(P<0.05),但术前、术后晚期差异无显著意义(P>0.05)。结论:胬肉切除联合带蒂结膜瓣移植术手术前后的泪液功能明显有改变,手术可使患者的泪液功能得到一定的恢复。

AIM：To estimate the influence of pterygium excision with autologous conjunctiva-flap transplantation upon tear film function in patients with pterygium. METHODS： All patients undergoing pterygium excision with autologous conjunctiva-flap transplantation received the tear film break-up time （BUT）, Schirmer I test and tear fern test （TFT） at preoperative 1 day and postoperative 3,7,30 days,conjunctival impression cytology （CIC） of tear film mucous layer was tested at 1 day before surgery and 30 days after surgery to evaluate the function of tear film. RESULTS： A total of 87 cases （87 eyes） enrolling in the current study, 45 cases were male, 42 cases were female. Patients＇ age ranged from 45 to 81 years with an average age of 64.1±8.8 years. Mean BUT at 30 days of follow-up was longer than that before surgery, they were 11.47±3.23 seconds and 9.43±3.25 seconds, respectively （P0.05）. The proportion of cases with normal results of TFT （graded as TypeⅠandⅡ）was 90% which was significant higher than that tested before surgery （P0.05）. Goblet cell density after surgery （39.73±18.46/10 high power microscopic） was higher than preoperative results （48.85±18.80/10 high power microscopic） with a significant difference（P0.05）. Improvement of Schirmer I test was found between first test and early tests after surgery （P0.05）, whereas it wasn＇t observed between the first and the last test （P0.05）. CONCLUSION：Pterygium excision with autologous conjunctiva-flap transplantation can improve the function of tear film.