翼状胬肉结膜移植术中不同缝线方法的疗效比较

Comparison of efficacy of three suture methods in pterygium conjunctival transplantation

目的评估埋线式缝合法应用于翼状胬肉切除联合自体结膜移植术中的效果,并比较其与连续缝合法和间断缝合法的差异。方法采用随机对照临床研究方法,纳入2020年5—7月在上海爱尔眼科医院就诊并行翼状胬肉切除联合自体结膜移植术的原发性翼状胬肉患者120例120眼。采用随机数表法将患者分为埋线法、连续缝合法和间断缝合法3个组,每组40眼。记录手术时长,并于术后第0.5、1、3、7、10、14天和第1、3、6个月进行随访。采用五点法记录术眼疼痛评分;采用荧光素钠染色法评估角膜上皮愈合情况;采用裂隙灯显微镜观察植片脱落、移位或翼状胬肉复发等并发症发生情况。结果连续缝合法、间断缝合法和埋线法的手术时间分别为(14.45±2.78)、(16.28±2.24)和(16.58±2.22)min,总体比较差异有统计学意义(F=8.98,P<0.05),其中连续缝合法手术时间明显短于间断缝合法和埋线法,差异均有统计学意义(均P<0.017),埋线法与间断缝合法相比差异无统计学意义(P>0.017)。3个组患者术后不同时间点疼痛评分总体比较差异有统计学意义(P<0.05),术后第0.5、1、3、7、10天,埋线法疼痛评分均低于连续缝合法及间断缝合法,差异均有统计学意义(均P<0.05)。术后第7天,3个组角膜上皮未愈合率总体比较差异无统计学意义(P=1.000);术后第10天,3个组角膜上皮均愈合。术后6个月,3个组均未出现植片移位、脱落、坏死及感染、眼球运动障碍等并发症。3个组翼状胬肉复发率总体比较差异无统计学意义(P=1.000)。结论埋线缝合法可有效减轻翼状胬肉结膜移植术后刺激症状,同时对植片固定具有良好的稳定性,与传统间断缝合法相比,其不增加复发率、不良反应发生率、手术时间以及患者的经济负担。

Objective To evaluate the efficacy of embedding suture in pterygium excision combined with autologous conjunctival transplantation,and to compare the differences between embedding suture,continuous suture and intermittent suture.Methods A randomized controlled study was conducted.One hundred and twenty patients(120 eyes)with primary pterygium,who underwent pterygium excision combined with autologous conjunctival transplantation in Shanghai Aier Eye Hospital from May to July 2020,were enrolled.The patients were randomly divided into the embedding suture group,continuous suture group and interrupted suture group,with 40 eyes in each group.The operation duration was recorded and the patients received follow-up visit at 0.5,1,3,7,10,14 days and 1,3 and 6 months after the operation.The five-point method was used to record the postoperative pain score.The corneal epithelial healing was evaluated by sodium fluorescein staining.The complications such as graft detachment,graft displacement or pterygium recurrence were observed with a slit lamp microscope.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Shanghai Aier Eye Hospital(No.SHAIER2020RB03).Written informed consent was obtained from each subject before any medical examination.Results The operation time of continuous suture,interrupted suture and embedding suture was(14.45±2.78),(16.28±2.24)and(16.58±2.22)minutes,respectively,and the overall difference was statistically significant(F=8.98,P<0.05).The operation time of continuous suture was significantly shorter than that of interrupted suture and embedding suture(both at P<0.017),and there was no significant difference between embedding suture and interrupted suture(P>0.017).There was a statistically significant overall difference in pain scores among the three groups at various time points after the operation(P<0.05).At 0.5,1,3,7 and 10 days after the operation,the pain scores of embedding suture were lower than those of continuous suture and interrupted suture(all at P<0.05).On the 7th day after the operation,there was no significant difference in the unhealed rate of corneal epithelium among the three groups(P=1.000).On the 10th day after the operation,the corneal epithelia of the three groups were all healed.During the six months after the operation,no complications such as displacement,detachment,necrosis,infection of graft and eye movement disorder occurred in the three groups.There was no significant difference in the recurrence rate of pterygium(P=1.000).Conclusions Embedding suture method can effectively reduce the irritation symptoms after pterygium conjunctival transplantation,and has stable fixation of implants.Compared with the traditional interrupted suture,it does not increase the recurrence rate,incidence of adverse reactions,operation time and economic burden of patients.