改良清创术联合结膜瓣遮盖术治疗真菌感染性角膜炎的临床效果及术后并发症研究

The clinical effect and postoperative complications of modified debridement combined with conjunctival flap covering in the treatmentof fungal infective keratitis

目的探索改良清创术联合结膜瓣遮盖术治疗真菌感染性角膜炎的临床效果,并观察术后并发症发生情况。方法从我院2017年1月-2019年12月期间收治的真菌感染性角膜炎患者中选择82例作为研究对象,按照入院顺序均分为观察组和对照组,对照组实施药物治疗+改良清创术治疗,观察组增加结膜瓣遮盖治疗,观察两组患者术后治愈率、治愈病程时间、二次手术发生率、角膜上皮修复时间、患眼视力改变和术后并发症发生情况。结果实验室检查发现病原菌51例(62.2%)为镰刀菌属,18例(22.0%)为曲霉菌属,9例(11.0%)为念珠菌属,3例(3.7%)为青菌属;对照组治愈率、好转率和无效率分别为69.3%、14.6%、19.5%,观察组分别为90.2%、7.3%、2.4%,两组比较差异均有统计学意义(x^2=8.973、6.254、9.136,均P<0.05);术前两组患者视力无明显差异(x^2=1.264,P>0.05),术后观察组患者视力优于对照组(x^2=7.928,P<0.05);观察组角膜上皮修复愈合时间为4.2±2.1d,疾病治愈病程时间为9.1±3.8d,对照组分别为5.7±1.9d和11.6±4.3d,差异均有统计学意义(t=7.143、8.257,均P<0.05);术后观察组有1(2.4%)例进行二次手术,对照组有6(14.6%)例行二次手术,观察组明显少于对照组(x^2=6.102,P<0.05),二次手术后效果均令人满意;术后对照组有7(17.0%)例出现并发症,观察组有5(12.2%)例出现并发症,两组患者并发症发生率无明显差异(x^2=1.225,P>0.05)。结论改良后的角膜溃疡清创术联合结膜瓣遮盖治疗真菌性角膜炎可提高临床疗效,且易于操作,容易推广应用,且不会增加并发症的发生。

Objetive To explore the clinical effect of modified debridement combined with conjunctival flap covering in the treatment of fungal infective keratitis,and to observe the postoperative complications.Method From January 2017 to December 2019 in our hospital,82 patients with fungal infection keratitis were selected as the study object.According to the order of admission,they were divided into the observation group and the control group.The control group was treated with drug therapy+improved debridement.The observation group was treated with conjunctival flap covering.The cure rate,duration of cure,incidence of secondary operation,corneal epithelium of the two groups were observed The time of repair,the change of visual acuity and the occurrence of postoperative complications.Result 51 cases(62.2%)were Fusarium,18 cases(22.0%)were Aspergillus,9 cases(11.0%)were Candida and 3 cases(3.7%)were cyanobacteria.The cure rate,improvement rate and inefficiency rate of the control group were 69.3%,14.6%and 19.5%respectively,and those of the observation group were 90.2%,7.3%and 2.4%respectively.The difference between the two groups was statistically significant(x^2=8.973,6.254 and 9.136,all P<0.05);There was no significant difference in visual acuity between the two groups before operation(x^2=1.264,P>0.05);The healing time of corneal epithelium in the observation group was4.2±2.1 d,the healing time of disease was 9.1±3.8 d,and that in the control group was 5.7±1.9 d and 11.6±4.3 d,respectively.The difference was statistically significant(t=7.143,8.257,all P<0.05);There were 1(2.4%)patients in the observation group and 6(14.6%)patients in the control group who underwent the second operation.The effect of the second operation in the observation group was significantly less than that in the control group(x^2=6.102,P<0.05);There were 7(17.0%)complications in the control group and 5(12.2%)complications in the observation group.Conclusion The improved corneal ulcer debridement combined with conjunctival flap covering treatment of fungal keratitis can improve the clinical efficacy,and is easy to operate,easy to promote the application,and will not increase the incidence of complications.