结膜松弛症患者球结膜淋巴管扩张的临床观察

Clinical observation of lymphangiectasis in conjunctivochalasis cases

目的探讨结膜松弛症发生发展与球结膜淋巴管扩张的关系。方法病例对照研究。上海中医药大学附属普陀医院眼科门诊2012年1月至3月就诊的60～80岁患者中，按结膜松弛症诊断标准连续入选100例作为研究对象；采用随机数字表法抽取100例非结膜松弛症的眼科患者作为临床对照组。用裂隙灯检查法观察球结膜淋巴管扩张情况，采用相干光断层成像（OCT）球结膜和筋膜图像扫描分析，手术切除淋巴管扩张区结膜组织病理学检查，并采用淋巴管特异性标记物D-240对组织进行免疫组织化学染色，Envision二步法鉴定。对各级结膜松弛症淋巴管扩张发生百分比进行）（。检验，对结膜松弛症等级与球结膜淋巴管扩张的数据进行相关性分析。结果100例（183只眼）结膜松弛症患者中伴有球结膜淋巴管扩张者29只眼，占15．84％；对照组100例（200只眼）球结膜淋巴管扩张者8只眼，占4．00％，两组差异有统计学意义（x2=15．36，P〈0．001）。按照结膜松弛症分级标准：I级中球结膜淋巴管扩张为8．60％，Ⅱ级中球结膜淋巴管扩张为12．96％，Ⅲ级中球结膜淋巴管扩张为37．03％，Ⅳ级中球结膜淋巴管扩张为44．44％。各级结膜松弛症淋巴管扩张发生百分比差异有统计学意义（x2=18．61P〈0．001）；结膜松弛症等级与球结膜淋巴管扩张发生有相关性（r=0．271，P〈0．001）。OCT扫描淋巴管扩张多为球结膜上皮下，部分位于球结膜固有层，边界清楚，囊腔内充满液体，有单腔或多囊腔，未累及筋膜。11例组织病理学显示球结膜固有层轻微的慢性炎症改变伴有大量淋巴管扩张，扩张的淋巴管腔内充满粉红色淡染的淋巴液，淋巴管标记物证实扩张的管腔为淋巴管。结论球结膜淋巴管扩张可能是结膜松弛症发生发展的原因之一，随着结膜松弛症分级增高，球结膜淋巴管扩张发生增加。

Objective conjunctivoehalasis and bulbar To investigate the relationship between the occm＇rence and development of conjunctival lymphangiectasia. Methods Case cortrol study. One hundred cases with conjunctivochalasis treated from January to March 2012 were selected to study, and 100 cases with no conjunctivoch alasis as the control group at the same time. To observe bulbar conjunctiva lymphatic duct dilatation using slit lamp microscope, analysis bulbar conjunctiva and fascia images by OCT scanning, and ablate lymphatic of conjunctival tissue for pathologic examine. Results Twenty-nine eyes of the bulbar conjunctiva lymphangiectasia associated with 100 cases （183 eyes） conjunctivochalasis patients, accounting for 15.84% ; 8 eyes of the ball conjunctival lymphatic dilation in control group of 100 cases （ 200 eyes）, accounting for 4. 00%. The difference between the two groups was statistically significant （ X2 = 15. 36, P 〈 0. 001 ）. OCT scanning showed that lymphangiectasia of the conjunctiva is at the subcutaneous mainly, some in the conjunetival lamina propria. They are border-clear, full-filled fluid, single-lumen or multi lumens, not involving the fascia. The histopathological examination showed that the lamina propria of the bulbarconjunctiva mildly chronic inflammatory changes accompanied by a large number of lymphangiectasia. Conclusion Bulbar conjunctival lymphangiectasia may be one of the reasons for the conjunctivochalasis.