翼状胬肉手术复发因素分析

Analysis on recurrence factors after pterygium surgery

目的分析翼状胬肉切除联合自体角膜缘干细胞移植术后复发原因,以指导围手术期处置。方法回顾我院68例（72只眼）翼状胬肉切除联合自体角膜缘干细胞移植术患者的临床资料,术后随访6个月,以上皮愈合稳定、角膜恢复正常光滑透明、无翼状胬肉样组织生长为治愈;角巩膜缘有新生血管或翼状胬肉样组织长入视为复发。观察患者术后翼状胬肉复发情况、并分析复发相关因素,指导术中及围手术期相关治疗。结果 68例（72眼）行翼状胬肉切除联合自体角膜缘干细胞移植术病例中,原发性翼状胬肉58例（61眼）,假性胬肉4例（4眼）,复发性胬肉6例（7眼）;68例患者中有高原地区患者3例（4眼）。术后6个月内复发6例7眼（9.8%）,其中1个月内复发1眼,1~3个月2眼,3~6个月4眼。复发病例中假性胬肉者复发1眼,高原患者1眼,睑板腺功能障碍1眼,干眼2眼,缝线刺激因素1眼,复发性胬肉者术后再次复发1眼。结论翼状胬肉术后复发与胬肉性质、环境因素、眼部环境及缝线刺激等因素有关。

OBJECTIVE To analyze and summarize the recurrence factors after excision of pterygium combined with limbal stem cell autograft transplantation surgery, so as to find references for perioperative management.METHODS Total 68 cases（72 eyes） that after excision of pterygium combined with limbal stem cell autograft transplantation surgery in our hospital were reviewed. The post-operative follow-up lasted for 6 months, and the cri-teria as recovery were corneal transparency with stable epithelial healing and no abnormal proliferation of ptery-gium-like tissue; the recurrence was defined as new vessels or pterygium-like tissue appeared at the corneal limbus.The recurrence condition after pterygium surgery was observed and the relevant recurrence factors were analyzed,whose results were used as guidance for intraoperative and perioperative management. RESULTS Among 68 case s（72 eyes） after excision of pterygium plus limba lstem cell transplantation surgery, 58 cases（61 eyes） were primary cases, 4 cases（4 eyes） were pseudo cases and 6 cases（7 eyes） were recurrent cases. In addition, 3 cases（4 eyes）were from plateau region. In the first 6 months after operation, 6 cases（7 eyes, 9.8%） were recurred, of which one eye happened within 1 month,2 eyes happened between first and third months,4eyes remitted between third and sixth months. Of the recurrence cases,1 eye was pseudo pterygium, 1 eye was palindromic pterygium, 1 eye was from plateau patient, 1 eye was from cases with meibomain gland dysfunction（MGD）, 2 eyes was complicated by dry-eye,1 eye suffered from suture stimulating factor, 1 eye was case after surgery for recurrence. CONCLUSION The recurrence of pterygium surgery had something to do with the property of pterygium, external environment, condition of the eye, suture and so on.