改良带角膜缘干细胞的游离结膜瓣移植术治疗翼状胬肉

Clinical study of modified free conjunctival flap transplantation with limbal stem cells in the treatment of pterygium

目的:探讨改良带角膜缘干细胞的游离结膜瓣移植术治疗翼状胬肉的临床疗效及对泪膜功能的影响。方法:病例对照研究。将我院2017-03/2021-03收治的60例60眼翼状胬肉患者,按随机数字表法分为对照组和观察组,各30例30眼,对照组给予翼状胬肉切除联合羊膜移植术治疗,观察组给予翼状胬肉切除联合改良带角膜缘干细胞的游离结膜瓣移植术治疗,治疗周期均为21d。比较两组患者临床疗效、手术时间、角膜创面修复时间,术前和术后1、3mo的干眼评分、泪膜破裂时间值和基础泪液分泌试验值以及不良反应发生情况。结果:观察组临床治疗总有效率高于对照组(χ^(2)=5.963,P=0.015),观察组手术时间长于对照组(t=-2.643,P<0.05),角膜创面修复时间短于对照组(t=2.182,P<0.05)。两组患者在术后1、3mo,干眼评分与术前比较均下降(均P<0.05),且观察组与对照组比较有差异(t=2.082、3.956,均P<0.05)。术后1、3mo泪膜破裂时间与术前比较均升高(均P<0.05),且观察组与对照组比较有差异(t=4.245、2.070,均P<0.05);术后1、3mo基础泪液分泌试验值与术前比较均升高(均P<0.05),且观察组与对照组比较有差异(t=2.076、2.223,均P<0.05)。两组患者的并发症发生率比较差异无统计学意义(P=0.572)。结论:改良带角膜缘干细胞的游离结膜瓣移植术可有效改善翼状胬肉患者临床症状,改善泪膜功能,利于术后角膜创面修复,不良反应发生率较低。

AIM:To investigate the clinical effect of modified free conjunctival flap transplantation with limbal stem cells in the treatment of pterygium and its impact on tear film function.METHODS:A total of 60 pterygium patients admitted to our hospital from March 2017 to March 2021 were randomly divided into the control group and the observation group,with 30 cases in each group.The control group was treated with amniotic membrane transplantation,and the observation group was treated with modified free conjunctival flap transplantation with limbal stem cells.The treatment period of both groups was 21d.And then the clinical efficacy,operation duration,corneal wound repair time,xerophthalmia score,tear film rupture time value and basic tear secretion test value before and 1,3mo after treatment,and the occurrence of adverse reactions were compared between the two groups.RESULTS:The total effective rate of clinical treatment in the observation group was higher than that of the control group(χ^(2)=5.963,P=0.015),the operation duration in the observation group was longer than that for the control group(t=-2.643,P<0.05),and the repair time of corneal wound was shorter than that of the control group(t=2.182,P<0.05).At 1 and 3mo after surgery,dry eye score in two groups decreased compared with that before surgery(all P<0.05),and there was a difference between observation group and control group(t=2.082,3.956;all P<0.05).The time of tear film rupture at 1 and 3mo after surgery was increased compared with that before surgery(all P<0.05),and there was a difference between the observation group and the control group(t=4.245,2.070;all P<0.05).The experimental value of basal tear secretion at 1 and 3mo after surgery increased compared with that before surgery(all P<0.05),and there was a difference between the observation group and the control group(t=2.076,2.223;all P<0.05).There was no significant difference in the incidence of complications between the two groups(P=0.572).CONCLUSION:The improved free conjunctival flap transplantation with limbal stem cells can effectively improve the clinical symptoms and tear film function of patients with pterygium,which is beneficial to the recovery of postoperative corneal wound,and can reduce the incidence of adverse reactions.