生物羊膜移植与带角膜缘的自体结膜移植治疗翼状胬肉的疗效观察

Efficacy of biotic amniotic membrane transplantation versus autologous conjunctival limbal transplantation for the treatment of pterygium

目的观察生物羊膜移植和带角膜缘的自体结膜移植两种手术方式治疗翼状胬肉的疗效。方法 77例（101只眼）患者随机分为两组,A组40例（52只眼）行翼状胬肉切除联合生物羊膜移植,B组37例（49只眼）行翼状胬肉切除联合带角膜缘的自体球结膜移植,术后炎症明显者加用0.02%丝裂霉素C点眼。术后随访10~36个月,观察两组复发率,比较两组角膜创面修复时间和术后使用丝裂霉素C的情况。结果 A组8只眼复发,复发率15.38%,B组2只眼复发,复发率4.08%;A组术后角膜创面平均修复时间（4.48±0.87）d,B组术后角膜创面平均修复时间（4.04±1.10）d,二者间差异有统计学意义（t=2.23,P〈0.05）;A组术后使用丝裂霉素C 14只眼（26.9%）,B组术后使用丝裂霉素C 3只眼（6.12%）,二者间差异有统计学意义（χ2=7.80,P〈0.01）。结论生物羊膜或者是带角膜缘的自体结膜移植,联合术后丝裂霉素C点眼均能减少翼状胬肉切除术后复发,但带角膜缘的自体球结膜移植术后角膜修复时间更短,局部炎症反应更轻。

Objective To observe the efficacy of biotic amniotic membrane transplantation versus autologous con- junctival limbal transplantation in the treatment of pterygium. Methods Seventy-seven patients （101 eyes） were randomly divided into two groups. Group A patients （40 cases, 52 eyes） received pterygium resection and biotic anmiotic membrane transplantation. Group B patients （37 cases, 49 eyes） received pterygium resection and autologous conjuncfival timbal transplantation. Mitomycin C （0.02%） was used for severe inflammatory reaction. All patients were followed-up for 10 - 36 months. Recurrence rate, corneal epithelial recovering time, and the rate of mitomycin C administration were compared between the two groups. Results Recurrence was notedin 8 eyes （15.38%） from group A, while in2 eyes （4.08%） from group B. The average corneal epithelial recovering time was 4.48 -0.87 days and 4.04 - 1.10 days for group A and B, respectively. The differences were statistical significant （ t =2.23, P 〈0.05）. The rate of mitomyein C administration was 26.9% in group A and was 6.12% in group B. There were statistical significant between two groups （ X^2 = 7.80, P 〈 0.01 ）. Conclusion Biological alnnion and autologous conjunetival limbal transplantation combined with mitomycin C can reduce the recurrence of pterygium excision, but transplantation of autologous conjuncfival timbal cornea resulted in faster recovery and milder inflammation.