两种方法切除翼状胬肉头部联合自体角膜缘干细胞移植术的疗效比较

Comparison of curative effects by two ways for excision of pterygium head combined with autogenous corneal limbus stem cell transplantation

目的比较两种不同方法切除翼状胬肉头部联合自体角膜缘干细胞移植术治疗原发性翼状胬肉的临床疗效。方法 74例(80眼)原发性翼状胬肉患者随机分为A组38例(41眼)与B组36例(39眼)。A组采用显微有齿镊逆行撕离翼状胬肉头部联合自体角膜缘干细胞移植术治疗,B组采用尖锐刀片切除翼状胬肉头部联合自体角膜缘干细胞移植术治疗,术后随访6个月~2年,比较角膜创面愈合时间及复发率。结果 A组术后角膜创面愈合时间为(2.5±1.1)d,1眼(2.44%)复发,3眼(7.32%)遗留角膜浅层云翳或斑翳;B组术后角膜创面愈合时间为(5.4±1.3)d,3眼(7.69%)复发,6眼(15.38%)遗留角膜浅层云翳或斑翳;两组术后复发率及遗留角膜浅层云翳或斑翳率比较差异无统计学意义(P>0.05),两组角膜创面愈合时间比较差异有统计学意义(P<0.05)。结论显微有齿镊逆行撕离翼状胬肉头部联合自体角膜缘干细胞移植术治疗原发性翼状胬肉能使角膜创面愈合更快,是一种理想而简便的手术方法 ,适合在基层推广。

Objective To compare clinical effects by two ways for excision of pterygium head combined with autogenous corneal limbus stem cell transplantation. Methods A total of 74 patients（80 eyes） with primary pterygium were randomly divided into group A with 38 cases（41 eyes） and group B with 36 cases（39 eyes）. Group A received microscopic retrograde rip of pterygium head by toothed forceps combined with autogenous corneal limbus stem cell transplantation for treatment. Group B received excision of pterygium head by sharp blade combined with autogenous corneal limbus stem cell transplantation for treatment. Follow-up lasted for 6 months～2 years to compare corneal wound healing time and recurrence rate between the two groups. Results Group A had postoperative corneal wound healing time as（2.5±1.1） d, 1 recurrent eye（2.44%） and 3 eyes with remaining shallow corneal nebula or macula（7.32%）. Group B had postoperative corneal wound healing time as（5.4±1.3） d, 3 recurrent eyes（7.69%） and 6 eyes with remaining shallow corneal nebula or macula（15.38%）. There was no statistically significant difference of postoperative recurrence rate, and remaining shallow corneal nebula or macula rate between the two groups（P〉0.05）. The difference of corneal wound healing time had statistical significance between the two groups（P〈0.05）. Conclusion Combination of microscopic retrograde rip of pterygium head by toothed forceps and autogenous corneal limbus stem cell transplantation in treating primary pterygium accelerates corneal wound healing. As an ideal and easily operational operation way, this method is suitable for promotion in primary level.