翼状胬肉的手术时机探讨

OPTIMAL TIME OF PTERYGIUM SURGERY

目的探讨翼状胬肉的手术时机。方法将66例翼状胬肉病人共70眼,按翼状胬肉侵入角膜的长度分为Ⅰ组(<2.5mm)、Ⅱ组(2.5~3.5mm)和Ⅲ组(>3.5mm),均行翼状胬肉切除并自体角膜缘干细胞移植术。观察比较3组手术前后散光、裸眼视力及术后复发率。结果术后3组病人裸眼视力、散光与术前比较,差异均有显著性(t=2.107~22.771,P<0.05);Ⅰ组病人术后裸眼视力改善程度最小,与其他两组相比,差异均有统计学意义(F=5.094,P<0.05),Ⅱ组病人术后裸眼视力改善程度与Ⅲ组相比差异无显著性(P>0.05)。Ⅲ组病人术后复发率最高(33.3%),与其他两组(5.0%、3.8%)相比,差异均有统计学意义(χ~2=5.382、7.352,P<0.05),Ⅰ组病人复发率与Ⅱ组相比差异无显著性(P>0.05)。结论翼状胬肉侵入角膜2.5~3.5mm时是手术最佳时机。

Objective To investigate the optimal time for pterygium surgery. Methods A total of 66 patients（70 eyes）with pterygium were divided into three groups according to the length of pterygium invasion into the cornea：group Ⅰ（2.5 mm）,groupⅡ（2.5-3.5 mm）,groupⅢ（3.5 mm）.All the patients underwent pterygium excision and autologous corneal limbal stem cell transplantation.Observations and comparisons were performed on astigmatism and uncorrected visual acuity（UCVA）before and after surgery and postoperative recurrence rates. Results The three groups showed significant improvements in UCVA and astigmatism after surgery（t=2.107-22.771,P0.05）.Group Ⅰ had a significantly less improvement in UCVA than the other two groups（F=5.094,P0.05）,but there was no significant difference in UCVA improvement between groupⅡ and groupⅢ（P0.05）.GroupⅢ had a significantly higher recurrence rate than the other two groups（33.3% vs 5.0%and 3.8%;χ~2=5.382,7.352;P0.05）.There was no significant difference in recurrence rate between groupⅠand groupⅡ（P0.05）.Conclusion The surgical effect is best for patients when the length of pterygium invasion into the cornea is 2.5-3.5 mm.