不同翼状胬肉切除范围的治疗效果比较

Comparison of the efficacy of pterygium with different surgical resection extents

目的比较翼状胬肉不同手术切除范围的治疗效果。方法回顾性队列研究。收集2012年6月至2021年6月解放军第910医院住院的238例(238眼)翼状胬肉患者,按手术方式不同分为A、B两组:A组(108例)仅切除增生明显的胬肉体部,保留相对较多的胬肉根部及周边筋膜囊组织。B组(130例)切除全部胬肉组织及其周边2 mm范围内筋膜囊组织。术后随访6个月。观察比较两组患者术眼不适情况、创面疤痕形成情况以及翼状胬肉复发情况。结果术后3 d,A、B两组出现术后不适的患者占比差异无统计学意义。术后1个月,仍有不适的患者占比A组高于B组,差异有统计学意义(P<0.01)。术后3个月,A组结膜瘢痕面积为(5.22±1.03)mm^(2),大于B组的(2.20±0.43)mm^(2)(t=28.49,P<0.001)。术后6个月,A组复发率为9.52%(10/105)高于B组的3.17%(4/126)(χ^(2)=4.06,P<0.05)。结论完整地切除翼状胬肉及其周边受累筋膜囊组织,可以明显降低术后不适感和瘢痕发生,减少复发。

Objective To compare the efficacy of pterygium with different surgical resection extents.Methods This was a retrospective case cohort study.From Jun.2012 to Jun.2021,238 eyes of 238 cases with pterygium inpatients in the 910th Hospital of the People’s Liberation Army were divided into group A and group B based on different surgical methods.In group A,108 cases removed only the significantly proliferative pterygium tissue,while retaining relatively more pterygium roots and surrounding fascia sac tissue.In group B,130 cases removed all pterygium tissue combined with surrounding fascia sac within 2 mm.Postoperative follow-up was 6 months.The eye discomfort,wound scarring and pterygium recurrence were observed and compared between the two groups.Results Within 3 days after surgery,there was no significant difference in the proportion of patients with discomfort between group A and group B.At 1 month after surgery,the proportion of patients who still had discomfort was higher in group A than that in group B,and the difference was statistically significant(P<0.01).At 3 months after surgery,the average conjunctival scar area in group A was(5.22±1.03)mm^(2),which was greater than that in group B(2.20±0.43)mm^(2)(t=28.49,P<0.001).At 6 months after surgery,the recurrence rate of group A was 9.52%(10/105),which was higher than that of group B(3.17%,4/126)(χ^(2)=4.06,P<0.05).Conclusion Extensive excision of pterygium can significantly reduce postoperative discomfort and scar,such as redness,itching,and foreign body sensation,with reduced recurrence.