兩種翼狀胬肉切除手術的同體異眼比較

1、兩種翼狀胬肉切除手術的同體異眼比較         11-03-03 11:23:00     編輯：studa20                      作者：范軍華，李學喜，潘棟平【摘要】  目的：在同體異眼上比較翼狀胬肉切除聯合角膜緣干細胞滑行移植術

2、和經典的胬肉切除聯合角膜緣干細胞移植術的效果。方法：選取105例210眼初發(fā)性翼狀胬肉患者，左右眼分別行胬肉切除聯合角膜緣干細胞滑行移植術(A術式)和經典的胬肉切除聯合角膜緣干細胞移植術(B術式)。術后隨訪12mo，比較雙眼術后不適癥狀的程度及持續(xù)時間、角膜上皮愈合時間以及翼狀胬肉復發(fā)情況。結果：A術式8眼翼狀胬肉復發(fā),復發(fā)率為7.8%;B術式6眼復發(fā),復發(fā)率為5.9%,兩組差異無統計學意義(P>0.05);在術后1wk，有86.7%患者訴行B術式的眼不適癥狀重于行 A術式的眼，術后1，2wk及1mo時，不適癥狀眼數A術式眼均 結論：翼狀胬肉切除聯合角膜緣干細胞滑行移植術與經典的胬肉切除

3、聯合角膜緣干細胞移植術相比，術后胬肉復發(fā)率無明顯差異，但具有簡便快捷，創(chuàng)傷小，修復快，術后患者自覺癥狀輕等優(yōu)點。 【關鍵詞】  翼狀胬肉/治療;角膜緣干細胞;眼科手術方法AbstractAIM: To compare the effects of excision of pterygium with gliding the corneal limbal stem cells beside pterygiumneck(A operation) and classical pterygium excision combined with corneal limbal stem cells

4、 transplantation(B operation) on different eyes of homobody.METHODS: There were 105 patients 210 eyes with initial pterygium in two eyes, one eye got A operation and the other got B operation. The postoperative followup period was 12 months. The duration of complaint symptoms, the time of corneal ep

5、ithelium healing and recurrence of pterygium were observed after operation.RESULTS: Eight eyes of 105 eyes that got A operation were recurred, the rate of recurred was 7.8%. 6 eyes of 105 eyes that got B operation were recurred, the rate of recurred was 5.9%. The difference was not significantly dif

6、ferent(P>0.05). 87.6% patients complained that the eyes got B operation were more uncomfortable.The duration of complaint symptoms after operation was significantly different between two operation(P<0.01). The time of corneal epithelium healing was also significantly different(P<0.05).CONCL

7、USION:The excision of pterygium with gliding the corneal limbal stem cells beside pterygiumneck is a convenient, microinjury and light compliant symptoms surgery. The rate of recurred is not significantly different between this operation and classical pterygium excision combined with corneal limbal

8、stem cells transplantation.KEYWORDS: pterygium/therapy; corneal stem cells; ophthalmologic surgical proceduresFan JH, Li XX, Pan DP. Effects of two surgical techniques for excision of pterygium on different eyes of homobody. Int J Ophthalmol(Guoji Yanke Zazhi) 2010;10(9):17881789翼狀胬肉是一種常見的眼表疾病，特別是在我

9、國東南沿海一帶發(fā)病率較高，嚴重影響了患者的美觀與視力。經典的胬肉切除聯合角膜緣干細胞移植術可以明顯降低術后復發(fā)率，但手術較為復雜，且容易對干細胞供區(qū)造成損傷。為此，我們設計了一種新型的胬肉切除方式，即翼狀胬肉切除聯合角膜緣干細胞滑行移植術，相比單純胬肉切除術，該手術具有簡便快捷，創(chuàng)傷小，修復快，術后刺激癥狀輕，復發(fā)率低，無瘢痕等優(yōu)點1。為進一步了解該新型手術方式與經典的胬肉切除并角膜緣干細胞移植術在術后復發(fā)率、舒適度等方面的差異，我們將兩種手術方式在同體異眼上進行了臨床對比，現報告如下。1對象和方法篩選200701/200807原發(fā)性雙眼翼狀胬肉要求手術105例210眼，男62例，女43例，年

10、齡2565歲。靜止期160眼，進展期50眼，進展期患者術前均點地塞米松眼液和抗生素眼液1wk，6/d。術中測量所有胬肉頸部與角膜緣相連的基底寬度均<3mm。所有患者均接受雙眼手術，隨機選1眼歸入A組，行胬肉切除并角膜緣干細胞滑行移植術，另1眼歸入B組，行經典胬肉切除并角膜緣干細胞移植術。圖1 胬肉切除聯合角膜緣干細胞滑行移植術后6d。胬肉切除聯合角膜緣干細胞滑行移植術(A術式)：按我們曾經報告的方法1進行手術。局部結膜下麻醉后于胬肉頸部沿角膜緣弧形剪開結膜，并以角膜緣為底邊，向內眥部“V”形剪除邊長約4mm的三角形結膜組織。鈍性分離胬肉體部后于淚阜前0.5mm處剪斷胬肉，最后提起胬肉組織

11、向角膜逆向鈍性分離。以刀片刮除角膜面及鞏膜面殘留的胬肉組織，盡量保持角膜創(chuàng)面光滑平整。燒灼鞏膜面止血后，沿胬肉頸部上下兩側角膜緣分離球結膜，分離時需進入透明角膜緣內約1mm，然后上下各剪開約35mm(具體視胬肉頸部的基底寬度決定)，之后將角膜緣兩側結膜拉合，遮蓋暴露的鞏膜創(chuàng)面，角膜緣對齊，并用100號尼龍線間斷縫合固定34針，縫合時帶少量淺層鞏膜。經典翼狀胬肉切除并角膜緣干細胞移植術(B術式)：按眼表疾病的基礎與臨床2所提供的方法手術：切除覆蓋于角鞏膜表面的胬肉組織，于1200位角膜緣處取邊長約6mm帶0.5mm透明角膜緣的結膜干細胞片，移植于結膜缺損區(qū)。手術完畢結膜下注射抗生素、涂氧氟沙星眼膏后術眼包扎，第2d換藥并涂氧氟沙星眼膏，以后不包