改良翼状胬肉切除术联合自体游离球结膜移植

Modified excision of pterygium combined with autogenous free bulbar conjunctival transplantation

目的观察运用改良胬肉切除方法，联合自体游离球结膜移植治疗翼状胬肉的疗效。方法角膜缘结膜切口，隧道式分离胬肉体部，上皮下剥离胬肉头部，巩膜缺损处行自体游离球结膜移植，对78例（90眼）原发性翼状胬肉手术，术后随访6～12个月，平均（9．85±2．36）个月。结果所有患者反应轻微，术后1—2d除轻微疼痛、异物感外无特殊不适，3—4d角膜上皮基本修复，荧光染色阴性。78例90眼中5眼因眼球早期过度运动，拆除缝线时结膜伤口哆开，无移位和脱落，2眼术后青光眼发作，1眼15d时发现结膜创口处肉芽增生，1眼术后1月发现结膜下积液隆起，局部淋巴液潴留，4眼术后3月复发（复发率4．44％），未发现其它并发症。结论通过胬肉切除术的改良，真正达到创伤小，反应轻，愈合快，胬肉组织切除彻底，手术安全，联合自体游离球结膜治疗，复发率较低。

Objective To investigate the therapeutic effect of using the method of improved pteryg- ium excision, combined with autogenous free bulbar conjunctiva transplantation for the treatment of primary pterygium. Methods Limbus conjunctiva incision, tunnel-like separation of pterygium body, Subepithelial split of pterygium head, autogenous conjunctival transplantation to scleral defect. 78 cases （90 eye） of pri- mary pterygium surgery, were followed up in postoperative 6 - 12 months, averaging （9.85 ± 2.36 ） months. Results All reactions in patients were mild, without any special discomfort except slight pain and foreign body sensation 1 - 2 days after operation. Corneal epithelium was basically recovered in postoperative 3 - 4 days, with negative fluorescent staining. Of the 78 eases （90 eyes）, 5 cases suffered from open of conjuncti- val wound upon demolition of suture due to early excessive eye movement, without shift and off, 2 cases suf- fered from glaucoma, 1 cases suffered from granulation hyperplasia on conjunctival wound on postoperative 15 days, 1 case was found subconjunctival liquid uplift, local Lymphoma liquid retention 1 month after opera- tion, 4 eyes suffered from recurrence （ recurrence rate 4.44% ）, without any other complications. Conclu- sion The improved excision of pterygium, achieves effect of small wound, slight reaction and faster heal- ing. The excision of pterygium was complete and safety, combined with autogenous free bulbar conjunctival transplantation, with lower recurrence rate and worthing promoting.