表麻下翼状胬肉联合自体角膜缘干细胞移植术疗效观察

Observation of clinical curative effect of improvement of pterygium combined with autologous limbal stem cell transplantation

目的观察表麻下翼状胬肉切除术联合自体角膜缘干细胞移植术的优点及临床疗效。方法临床病例对照研究。选取北京华信医院眼科门诊自2012年6月至2013年12月的符合手术适应证的患者，49例52只眼。设实验组29例30只眼（其中2例为复发患者），采取表麻下行翼状胬肉切除术联合自体角膜缘干细胞移植术；对照组20例22只眼结膜下行局麻翼状胬肉切除术联合自体角膜缘干细胞移植术；对二者的患者创面愈合时间，翼状胬肉复发情况，术后并发症情况等进行比较。结果术后10天、1、6个月复查，采用表麻下行翼状胬肉切除术联合自体角膜缘干细胞移植术的患者术中出血明显减少，缩短了手术时间，患者术后恢复好，无一眼复发；局麻下手术组复发1只眼，复发率为4．5％，实验组患者术后创面愈合时间短于对照组患者，差异有统计学意义（P〈0．01），实验组较对照组术后并发症少，组间比较具有统计学差异（P〈0．05）。结论应用表麻下行翼状胬肉切除术联合自体角膜缘干细胞移植术能减短手术时间，减少术中出血，加速角膜上皮愈合速度，减少复发率和术后并发症的发生，显著提高视力，疗效确切，值得临床推广应用。

Objective To observe the advantage and clinical effect of technique in the excision of pterygium combined with autologous corneal limbal stem cells transplantation under using the permeation analgesia. Methods The data of 49 cases （52 eyes） with pterygium which were randomly selected according to surgery indication in our hospital outpatient from June 2012 to December 2013 was analyzed. Patients applied the permeation analgesia were classified as the experimental group （29 cases 30 eyes） and the others applied the toponarcosis were classified as the control group （20 cases 22 eyes）. All cases were treated with pterygium excision combined with autologous corneal limbal stem cells transplantation. Two groups were randomly classified according to the difference of anesthesia method, and comparing the wound healing time, recurrence of pterygiurn, post-operative com- plications of the patients. Results The follow-up results showed that the experimental group had short surgery time and condition of intraoperative hemorrhage were obviously decreased 10 days, 1 month, 6 months, respectively, after operation. The patients recovered well after surgery and had lower relapse rate in postoperative. No relapse was occurred until publication. Relapse rate of control group was 4.5%. Postoperative wound healing time of the experimental group patients was shorter than that of the control group, the difference had very significant statistical significance （P 〈0.01）, the experimental group had less postoperative complications than the control group, there was statistical significance between the groups （P 〈0.05）. Conclusions The excision of pterygium combined with autologous corneal limbal stem cells transplantation under using the permeation analgesia is able to shorten surgery time, reduce intraoperative hemorrhage, accelerate corneal epithelium recovery, reduce the recurrence rate and postoperative complications and have lower relapse rate. The excision of pterygium combined with autologous corneal lirnbal stem cells transplantation under using the permeation analgesia has certain curative effect and is worth of clinical application.