病灶清创及结膜瓣遮盖术治疗真菌性角膜溃疡

Debridement combined with conjunctival flap covering for the treatment of fungal keratitis

目的探讨病灶清创联合结膜瓣遮盖术治疗真菌性角膜溃疡的手术效果。方法我院真菌性角膜溃疡28例（28眼），抗真菌药物治疗5～7d后，无明显好转或加重，行病灶清创联合结膜瓣遮盖术。局部麻醉下从浸润的边缘外1mm开始剥除板层坏死组织，显露正常角膜组织，将溃疡灶的堤状隆起的边缘修平，使清创后的创面较平整；根据溃疡面的大小和位置制作结膜瓣，位于周边者选择单蒂舌形结膜瓣；位于中央或旁中央者选用桥形双蒂结膜瓣；接近全角膜感染选用全角膜结膜瓣遮盖。结果随访1月至半年，27（96．43％）例结膜瓣与角膜形成良好愈合，无溃疡复发；1例（3．57％）病情严重者2周后向深层浸润并波及眼内，最终丧失眼球。结论此手术操作简单，取材方便，费用低，尤其适合基层医院，能有效降低真菌性角膜溃疡的危害和致盲率。

Objective To investigate the effect of focal cleaning combined with conjunctival flap covering on the treatment of fungal keratitis. Methods Twenty-eight eyes of 28 cases diagnosed with fungal keratitis were retrospectively analysed. After using anti-fungal drugs for 5 to 7 days, all cases did not get better or grew worse. Then focal debridement combined with conjunctival flap covering were performed. Under local anesthesia, necrotic tissues were excised from l mm away from the infiltrative edge, to where normal corneal tissue exposed. The upwarping zone around the ulcer lesion was removed to make the surface smooth. The size and shape of conjunctival flap were dicided by the area and location of corneal ulcer. Tongue-shape flaps were used for peripheral ulcer, bridge-shape flaps were choosed if ulcer located in the corneal centre, and the whole cornea should be covered if ulcer infiltrated all around the cornea. Results The follow-up period was from 1 month to 6 months. Ulcer of 27 cases（96.43% ） were healed and did not recur. The remaining one （3.57%） was under serious condition, and two weeks after operation the ulcer infiltrated into the corneal deep layer and spread to the inside of the eye. Eventually the patient lost the eye. Conclusion This kind of operation is simple, convenient, low cost and especially suitable for primary level hospital, which can effectively reduce the damage and blindness caused by fungal corneal ulcer.