中药在阴虚火旺型翼状胬肉术后应用的临床观察

Clinical observation on application of Traditional Chinese Medicine for pterygium with Yin deficiency and fire exuberance type after operation

目的观察中药在阴虚火旺型翼状胬肉术后应用的临床疗效。方法纳入阴虚火旺型翼状胬肉患者206例(206只眼),随机分为对照组50例(50只眼),角膜绷带镜组52例(52只眼),中药组52例(52只眼),结合组52例(52只眼)。对照组:予基础治疗,行翼状胬肉切除联合自体游离结膜移植术;角膜绷带镜组:予基础治疗,术毕立即配戴博士伦纯视软性亲水性接触镜;中药组:予基础治疗,术后即开始口服中药治疗;结合组:予基础治疗,术毕立即配戴博士伦纯视软性亲水性接触镜及口服中药治疗。观察4组角膜上皮缺损完全修复时间、结膜充血消退时间、胬肉复发率。结果(1)角膜上皮缺损完全修复时间:对照组5(4,6)d,角膜绷带镜组4(4,5)d,中药组2.5(2,3)d,结合组2(2,2)d。与对照组比较,角膜绷带镜组、中药组、结合组角膜上皮缺损修复时间均缩短,有统计学意义(Z=-4.572、-8.174、-8.788,均P=0.000);与角膜绷带镜组比较,中药组、结合组角膜上皮缺损修复时间均缩短,有统计学意义(Z=-7.370、-8.749,均P=0.000);与中药组比较,结合组角膜上皮缺损修复时间缩短,有统计学意义(Z=-4.071,P=0.000)。(2)结膜充血消退时间:对照组25(24,27)d,角膜绷带镜组23(22,25)d,中药组15(15,17)d,结合组15(14,16)d。与对照组比较,角膜绷带镜组、中药组、结合组结膜充血消退时间均缩短,有统计学意义(Z=-4.119、-8.628、-8.731,均P=0.000);与角膜绷带镜组比较,中药组、结合组结膜充血消退时间均缩短,有统计学意义(Z=-8.320、-8.771,均P=0.000);与中药组比较,结合组结膜充血消退时间缩短,有统计学意义(Z=-1.973,P=0.049)。(3)复发率:术后随访1年,对照组复发2例(4.00%);角膜绷带镜组复发2例(3.85%);中药组复发1例(1.92%);结合组复发1例(1.92%),差异无统计学意义(X^2=0.742,P=0.863)。结论翼状胬肉切除联合自体游离结膜移植术后,联合应用中药可以更快促进翼状胬肉术后角膜上皮缺损修复及结膜充血消退,改善畏光、流泪、疼痛症状,但尚不能降低翼状胬肉的复发率。

OBJECTIVE To observe the clinical effect of Traditional Chinese Medicine on pterygium with Yin deficiency and fire exuberance type after operation.METHODS A total of 206 patients(206 eyes)with Yin deficiency and fire exuberance type pterygium were enrolled.The patients were randomly divided into control group 50 cases(50 eyes),corneal bandage lens group 52 cases(52 eyes),Traditional Chinese Medicine group 52 cases(52 eyes),and combination group 52 cases(52 eyes).The control group received basic treatment in addition to pterygium excision combined with free conjunctival autotransplantation;the corneal bandage lens group received basic treatment,and were immediately fitted with a soft hydrophilic contact lens of bausch&lomb pure vision after operation;the Traditional Chinese Medicine group received basic treatment and oral Traditional Chinese Medicine treatment was started immediately after operation;the combination group received basic treatment,were immediately fitted with a soft hydrophilic contact lens of bausch&lomb pure vision after operation as well as oral administration of Traditional Chinese Medicine after operation.The complete repair time of the corneal epithelial defect,the disappearance time of conjunctival congestion and the recurrence rate of pterygium in all groups were observed.RESULTS(1)The complete repair time of corneal epithelial defect was 5(4,6)days in the control group,4(4,5)days in the corneal bandage lens group,2.5(2,3)days in the Traditional Chinese Medicine group,2(2,2)days in the combination group.Compared with the control group,the repair time of corneal epithelial defect in the corneal bandage lens group,the Traditional Chinese Medicine group and the combination group were shorter,and differences were statistically significant(z=-4.572,-8.174,-8.788,P=0.000);compared with the corneal bandage lens group,the repair time of corneal epithelial defect in the Traditional Chinese Medicine group and the combination group were shorter,and differences were statistically significant(z=-7.370,-8.749,P=0.000);compared with the Traditional Chinese Medicine group,the repair time of corneal epithelial defect in the combination group was shorter and the difference was statistically significant(z=-4.071,P=0.000).(2)The disappearance time of conjunctival congestion was 25(24,27)days in the control group,23(22,25)days in the corneal bandage lens group,15(15,17)days in the Traditional Chinese Medicine group,15(14,16)days in the combination group.Compared with the control group,the disappearance time of conjunctival congestion in the corneal bandage lens group,Traditional Chinese Medicine group and the combination group were shorter,and differences were statistically significant(z=-4.119,-8.628,-8.731,P=0.000);compared with the corneal bandage lens group,the disappearance time of conjunctival congestion in the Traditional Chinese Medicine group and the combination group were shorter,and differences were statistically significant(z=-8.320,-8.771,P=0.000);compared with the Traditional Chinese Medicine group,the disappearance time of conjunctival congestion in the combination group was shorter,and difference was statistically significant(z=-1.973,P=0.049).(3)After 1 year follow-up,2 cases recurred in the control group(4.00%),2 cases recurred in the corneal bandage lens group(3.85%),1 case recurred in the Traditional Chinese Medicine group(1.92%),1 case recurred in the combination group(1.92%),the difference were not statistically significant(X^2=0.742,P=0.863).CONCLUSIONS After pterygium excision with free conjunctival autotransplantation,the dominated application of Traditional Chinese Medicine accelerated the repair of corneal epithelial defect and the disappearance of conjunctival congestion,ameliorated photophobia tearing and pain symptoms after pterygium excision,but it could not reduce the recurrence rate of pterygium.