翼状胬肉切除游离结膜瓣移植术联合生物羊膜对泪膜功能的影响

Effect of pterygium excision free conjunctival flap transplantation combined with biological amniotic membrane on tear film function

目的分析翼状胬肉切除游离结膜瓣移植术联合生物羊膜移植术对患者泪膜功能的影响。方法随机对照研究。收集浙江永康瑞侦医院2021年1月至2022年1月患者146例(146眼)翼状胬肉。通过电子病历系统收集患者临床资料,其中男性80例,女性66例,年龄(59.76±7.18)岁,病程(10.58±2.66)年,翼状胬肉侵入角膜缘距离为(3.52±0.38)mm。按照随机数字表法分成两组,对照组73例(73眼)进行单纯翼状胬肉切除术;观察组73例(73眼)进行翼状胬肉切除游离结膜瓣移植术联合生物羊膜移植,术后随访半年。比较两组的疗效,记录两组手术用时、角膜上皮愈合时间、泪膜破裂时间、基础泪液分泌长度、角膜荧光染色评分、疼痛评分、舒适评分,观察术后翼状胬肉复发情况。结果术后半年观察组总有效率为94.52%(69/73)高于对照组79.45%(58/73)(χ^(2)=7.32,P=0.007);观察组手术用时、角膜上皮愈合时间均明显低于对照组(t=44.80、9.89,均P<0.01);末次随访时,观察组角膜荧光染色评分低于对照组(t=4.56,P<0.01),观察组泪膜破裂时间,基础泪液分泌长度高于对照组(t=6.69、5.62,均P<0.01);术后,观察组舒适评分高于对照组(t=9.22,P<0.01),观察组疼痛评分低于对照组(t=4.12,P<0.01);观察组复发率为1.37%(1/73)低于对照组16.44%(12/73)(χ^(2)=10.21,P=0.001)。结论翼状胬肉切除游离结膜瓣移植术联合生物羊膜移植,可以改善患者泪膜功能的稳定性。

Objective To analyze the effect of pterygium excision free conjunctival flap transplantation combined with biological amniotic membrane transplantation on tear film function in patients with pterygium.Methods This was a randomized controlled study.From Jan.2021 to Jan.2022,146 eyes of 146 patients with pterygium were selected from Zhejiang Yongkang Ruizhen Hospital.The clinical data of the patients were collected through the electronic medical record system,including 80 males and 66 females,aged(59.76±7.18)years,course of disease(10.58±2.66)years,and the distance of pterygium invading the corneal limbus was(3.52±0.38)mm.According to the random number table method,they were divided into two groups.In the control group 73 eyes of 73 cases underwent simple pterygium excision.In the observation group,73 eyes of 73 cases were treated with pterygium excision and free conjunctival flap transplantation combined with biological amniotic membrane transplantation.The efficacy of the two groups were compared.The operation time,corneal epithelial healing time,tear film rupture time,basic tear secretion length,corneal fluorescence staining score,pain score and comfort score of the two groups were recorded.Results The total effective rate of the observation group(94.52%,69/73)was higher than that of the control group(79.45%,58/73)(χ^(2)=7.32,P=0.007).The operation time and corneal epithelial healing time in the observation group were significantly lower than those in the control group(t=44.80,9.89;all P<0.01).At the last follow-up,corneal fluorescence staining score in the observation group was lower than that in the control group(t=4.56,P<0.01).The tear film rupture time and basic tear secretion length in the observation group were higher than those in the control group(t=6.69,5.62;all P<0.01).After operation,the comfort score of the observation group was higher than that of the control group(t=9.22,P<0.01),and the pain score of the observation group was lower than that of the control group(t=4.12,P<0.01).The recurrence rate of the observation group(1.37%,1/73)was lower than that of the control group(16.44%,12/73)(χ^(2)=10.21,P=0.001).Conclusion Pterygium excision free conjunctival flap transplantation combined with biological amniotic membrane transplantation can improve the stability of tear film function.