翼状胬肉的逆向撕剥、结膜移植和巩膜强化固定法的疗效

Efficacy of pterygium reversal tear-cutting,conjunctival autograft and sclera reinforcement fixation

目的:探讨一种改良的翼状胬肉切除术的疗效,以提高手术质量。方法:首先从角膜缘处将胬肉从颈部剪断,再用刀尖从胬肉头部边缘外0.5mm处掀开胬肉头部,然后将胬肉从头部向颈部,即沿其生长反方向撕扯,遇到粘连较重处,用刀尖(可为15°刀、尖刀片、钻石刀等)在角膜的切线方向上平推,以辅助撕剥,剪除结膜下方的胬肉组织,从同一眼颞上方取一与暴露巩膜面等大的结膜瓣,间断缝合固定于浅层巩膜上。结果:该法共实施于660眼,术后随访3mo,仅8眼复发,且手术时间、角膜上皮的愈合时间明显短于其他方法,角膜的光滑度和透明度、结膜的平整度均优于其他方法,恢复时间也明显缩短。结论:逆向撕剥、结膜移植、巩膜强化固定法治疗翼状胬肉的疗效明显优于传统的单纯切除法。

AIM：To introduce a modified pterygium excision,so as to improve the operation quality.METHODS：To cut the neck of the pterygiumat at limbus,then tear pterygiumat from opposite direction of head on the basis of the original excision.When resistance occurs,point of a knife（15° knife,pointed blade or diamond knife） was employed for cutting on the direction of tangent to cornea.In the process,the operation gave priority to tearing and was supplemented by cutting.A conjunctival flap was taken from the superior temporal and same size as the cut area.Conjunctival transplantation should be firmly stitched on the sclera.RESULTS：The implementation was taken on 660 eyes.There were only 8 eyes relapsed,and the smoothness and transparency of cornea was superior to the conventional method.Recovery time was shortened obviously.CONCLUSION：The modified method of reversal tear-cutting,conjunctival autograft and sclera reinforcement fixation is more effective than the conventional transplantation for treating pterygiumat.