改良结膜瓣转位术(下方)和羊膜移植术治疗翼状胬肉的临床疗效

Clinical efficacy of improved conjunctival flaps(inferior)and amniotic transplantation in treatment of pterygium

目的比较和探讨改良结膜瓣转位术(下方)和羊膜移植术对翼状胬肉的治疗效果。方法喀什地区94例(94眼)原发性翼状胬肉患者,根据手术方案不同随机分为两组,羊膜移植组行翼状胬肉切除联合羊膜移植共47例(47眼),结膜瓣转位组行翼状胬肉切除联合改良结膜瓣转位术(下方)共47例(47眼)。结果分别在术后1 d、1周、1、3、6个月观察刺激症状(畏光流泪、疼痛、异物感)、复发率及并发症(感染、眼球运动受限、睑球粘连、巩膜溶解坏死、结膜囊肿)的发生率,完成随访94例(94眼)。早期随访(术后1 d、1周)羊膜移植组患者自觉刺激症状明显比结膜瓣转位组严重,后期随访(术后1、3、6个月)羊膜移植组翼状胬肉复发率为19.15%,出现3例并发症(1例巩膜溶解坏死、2例结膜囊肿),并发症发生率为6.38%;结膜瓣转位组翼状胬肉复发率为6.38%,无并发症发生,两组间复发率差异无统计学意义(P=0.064),并发症差异无统计学意义(P=0.242);汉族患者无并发症发生,未出现复发病例,维吾尔族患者复发12例,出现3例并发症,差异无统计学意义(P> 0.05)。结论翼状胬肉切除联合改良带蒂结膜瓣转位术(下方)保留了上方球结膜,为日后的其他眼科手术留下了宝贵的手术空间,操作简便,无需增加羊膜等材料,经济适用,在基层医院值得进行临床应用推广;在相同手术条件下,汉族和维吾尔族的术后复发率和并发症无明显差异。

Objective To comparatively analyze the therapeutic effects of improved conjunctival flaps(inferior)and amniotic transplantation in treatment of pterygium.Methods Ninety-four patients with primary pterygium in Kashgar were randomly divided into amniotic transplantation group(47 patients,47 eyes,underwent pterygium excision with amniotic transplantation)andconjunctival flap group(47 patients,47 eyes,underwent pterygium excision with improved conjunctival flaps(inferior)).Results We completed the follow-up in all patients(94 eyes)1day,1week,1,3 and 6m after the surgery for the irritation symptoms(photophoby and lacri-mation,pain,foreign body sensation),the recurrence rate of pterygium and the rate of complications(infection,limitation of eye movement,symblepharon,sclera necrosis,conjunctiva cyst).In early postoperative phase(1day and 1week after the surgery),the irritation symptoms in amniotic transplantation group were more serious than those in conjunctival flaps group.One month,3 and 6 months after the operation,the recurrence rate of pterygium in amniotic transplantation group was 19.15%and when compared with that of 6.38%in conjunctival flap group,no statistically significant difference was observed(P=0.064);in amniotic transplantation group,the incidence of postoperative complications reached 6.38%(1 case of sclera necrosis,2 of conjunctiva cyst),but no postoperative complications in conjunctival flaps group and it indicated no statistically significant difference(P=0.242).There were no postoperative complication and recurrence case in Han nationality,while there were 12 cases of recur-rence and 3 with postoperative complications(1 case of sclera necrosis and 2 of conjunctiva cyst)in the Uygur.Conclusion Improved conjunctival flaps(inferior)could save more space for later ophthalmic surgery,which is worthy of clinical application in basic hospital;under the same surgical conditions,recurrence rate and postopera-tive complication rate in Uygur and in Han nationality are not statistically significant.