眼表面重建术对复发性翼状胬肉根治效果的对照研究

Comparative study of radical cure effects of ocular surface reconstruction for recurrent pterygium

目的 :探讨复发性翼状胬肉根治性治愈的最佳手术方法。方法 :在根治性切除基础上 ,联合行改良设计的眼表面重建术治疗复发性翼状胬肉 39眼 ,与角巩膜缘重建术治疗复发性翼状胬肉 2 1眼进行对照性分析 ,以术后纤维血管组织增生为评价标准 ,平均随访时间 13.2 5± 3.17个月。结果 :角巩膜缘重建术组 (2 1眼 )获得根治性治愈者 16眼占 76 .19% ,真性复发者 1眼占 4.7% ,具有明显纤维血管组织增生 ,但未超过角膜缘 ,提示有潜在复发可能者 4眼达 19.0 5 %。眼表面重建术组 (39眼 )全部获得根治性治愈 ,均未出现术后纤维血管组织增生 ,两组间比较、 (x2检验 ,x2值为 9.44 3,p<0 .0 0 5 ) ,具有非常显著统计学差异。两组均未出现明显术后并发症。结论 :对复发性翼状胬肉行根治性切除联合眼表面重建术可完全消除术后纤维血管组织增生 ,达到彻底根治的理想效果 ,该方法应推荐作为治疗复发性翼状胬肉 ,特别是伴有睑球粘连者的首选术式。

To evaluate the best surgical procedure which can obtain the radical cure effects for recurrent pterygia.Methods:39 eyes of recurrent pterygia,which were performed the excision thoroughly,underwent the modified ocular surface reconstruction.The results were compared with that of corneoscleral limbal reconstruction on 21 eyes of recurrent pterygia.The subepithelial fibrovascular proliferation postoperatively was used as the analysed sign.The average mean time of follow-up was 13.25±3.17 months.Results:16 eyes(76.19%)out of 21 in corneoscleral limbal reconstruction group achieved the radical cure.Clinical real recurrence was observed in only 1 eye(4.76%),and the significant fibrovascular proliferation which did not invade the limbus was noted in 4 eyes (19.05%).None of eyes in the modified ocular surface reconstruction group showed the subepithelial fibrovascular proliferation and all achieved the radical cure totally.The very significant differance was obtained between the two groups(x 2-test,x 2value was 9.443,p<0.005).No serious complications appeared.Conclusone:The modified ocular surface reconstruction combined with radical excision can eliminate thoroughtly the postoperative fibrovascular proliferation for recurrent prerygium and the best effects of radical cure are obtained.This procedure should be introduced as the first choice for recurrent pterygium,especially for which is associated with symblepharon.