不同术式治疗翼状胬肉的疗效分析

Efficacy analysis of three surgical methods in treatment of pterygium

目的:比较巩膜暴露法、带球结膜瓣的角膜缘干细胞移植术、带球结膜瓣的角膜缘干细胞移植术联合术中封闭球结膜与Tenon囊之间间隙的手术方式治疗翼状胬肉的临床疗效。方法:翼状胬肉患者130例138眼,分为三组:A组(45例,48眼):采用巩膜暴露法行翼状胬肉切除术;B组(42例,45眼):带球结膜瓣的角膜缘干细胞移植术;C组(43例,45眼):翼状胬肉切除联合带球结膜瓣的角膜缘干细胞移植术及封闭球结膜与Tenon囊之间间隙。术后随访12mo。结果:三组复发率分别为27.1%,8.9%,4.4%。A组与其余两组比较存在显著差异(P<0.05),B组与C组存在差异,但无统计学意义。肉芽肿形成:A组3眼,B组2眼,C组未见。C组泪阜的形态及位置明显优于A组及B组。结论:带球结膜瓣的角膜缘干细胞移植术联合术中封闭球结膜与Tenon囊之间间隙能显著降低翼状胬肉术后复发率,减轻炎症反应,预防肉芽肿的形成,有助于恢复泪阜的正常形态及位置,是目前治疗翼状胬肉的较理想手术方式。

· AIM： To investigate and compare the efficacy of bare sclera technique, corneal limbus stem cells conjunctival transplantation and corneal limbus stem cells conjunctival transplantation plus sealing the gap between the conjunctiva and Tenon＇s capsule in the treatment of pterygium. · METHODS： One hundred and thirty-eight eyes of 130 subjects were included in this study. Forty-eight eyes were excised with bare sclera technique （group A）. Fortyfive eyes were treated with corneal limbus stem cells conjunctival transplantation combined with excision （group B）, and forty-five eyes were treated with corneal limbus stem cells conjunctivat transplantation plus sealing the gap between the conjunctiva and Tenon＇s capsule （group C）. All patients completed 12 months of follow-up. · RESULTS： The recurrence rates of pterygium for the three surgeries （group A, B, and C） were 27.1%, 8.9% and 4.4%, respectively. The significant differences were identified when comparing the recurrence rate between group A and group B and between group A and group C （P〈0.05）. There was no statistically significant difference between group B and group C（P〉0. 05）. Granulomas appeared in group A （3 eyes） and group B （2 eyes）. The appearance of lacrimal caruncles in group C was better than those in group A and B. · CONCLUSION： Corneal limbus stem cells conjunctival transplantation plus sealing the gap between the conjunctiva and Tenon＇s capsule with excision can significantly reduce pterygium recurrence and make for appearance of lacrimal caruncles. It can release postoperative inflammation and prevent granulomas. It is an ideal method of pterygium surgery.