不同翼状胬肉切除术式对患者术后泪膜功能的影响

Effects of different surgical methods of pterygium on the function of tear film

目的:研究不同翼状胬肉切除术式对患者术后泪膜功能的影响。方法:回顾性研究,选择2016-10/2018-10翼状胬肉患者106例106眼,随机分成羊膜组和干细胞组,羊膜组(50例50眼)行翼状胬肉切除联合羊膜移植术,干细胞组(56例56眼)行翼状胬肉切除联合带角膜缘干细胞的自体结膜移植术。分别记录并分析术前和术后1、3mo时BUT、SⅠt和OSDI评分。结果:两组患者BUT和SⅠt均为术前最低,术后3mo最高;OSDI评分均为术前最高,术后3mo最低;手术前后不同时间点间各观察指标差异均有统计学意义(P<0.01)。(1)组间比较:术前和术后1mo时BUT、SⅠt、OSDI评分,两组间无差异(P>0.05),术后3mo干细胞组的BUT、SⅠt明显高于羊膜组(P<0.05),干细胞组的OSDI明显好于羊膜组(P<0.05)。(2)组内比较:三个时间点之间两两比较,术后1mo与术前相比无差异(P>0.05),术后3mo与术前、术后1mo相比有差异(P<0.05)。结论:翼状胬肉切除联合羊膜移植或联合带角膜缘干细胞的自体结膜移植均能有效改善患者术后泪膜功能,但后者的效果更明显。

AIM: To evaluate the different surgical methods on the function of tear film after pterygium surgery. METHODS: A retrospective case series study, a total of 106 pterygium patients (106 eyes) were randomly divided into two groups, 50 patients (50 eyes) received pterygium excision combined with amniotic membrane transplantation served as membrane group, 56 patients (56 eyes) received pterygium excision combined with autologous limbal stem cell transplantation served as stem cell group. Respectively before surgery and 1mo, 3mo after surgery, the BUT, SⅠt, OSDI were checked. The data were compared and analyzed. RESULTS: There were significant differences in different times of two groups.(1) Compared between groups, before operation and 1mo after surgery. There were no significant differences among BUT, SⅠt and OSDI ( P >0.05). But 3mo after surgery, BUT and SⅠt of the stem cell group was higher than the membrane group ( P <0.05). OSDI of the stem cell group was better than the membrane group ( P <0.05).(2) Compared within group, BUT, SⅠt and OSDI were no significant differences between before operation and 1mo after surgery ( P >0.05), but there were significant differences between 3mo after surgery and 1mo after surgery, before operation ( P <0.05). CONCLUSION: The function of tear film was restored by pterygium excision combined with amniotic membrane transplantation or combined with autologous limbal stem cell transplantation, and the later was better than the former in effect.