翼状胬肉切除术联合角膜缘干细胞移植术治疗翼状胬肉的效果

吴庆伟+吴志群+林树燕

[摘要]目的 观察翼状胬肉切除术联合角膜缘干细胞移植术治疗翼状胬肉的效果。方法 选取2016年4月～2017年1月在我院进行治疗的翼状胬肉患者50例，共81眼，根据随机数字表法分为两组，其中观察组40眼，行翼状胬肉切除联合角膜缘干细胞移植术，对照组41眼，行单纯翼状胬肉切除术。比较两组的疗效。结果 两组术后1、3个月的泪膜破裂时间（BUT）与术前差异有统计学意义（P<0.05）；对照组术后5 d的BUT较术前缩短，差异有统计学意义（P<0.05）。两组术后5 d的BUT差异有统计学意义（P<0.05）。两组术后1、3个月的高阶像差测量（t-HOA）较术前显著降低，差异有统计学意义（P<0.05）。两组各个时间点的t-HOA差异无统计学意义（P>0.05）。观察组的Ⅲ～Ⅳ级比例低于对照组（5.0% vs. 21.9%）（P<0.05）。结论 翼状胬肉切除术联合角膜缘干细胞移植术的疗效可靠，有助于提高视觉质量。

[关键词]翼状胬肉切除术；角膜缘干细胞移植术；眼表；翼状胬肉

[中图分类号] R777.33 [文献标识码] A [文章编号] 1674-4721（2017）06（c）-0028-03

[Abstract]Objective To observe the effect of pterygium excision combined with limbal stem cell transplantation surgery treating pterygium.Methods 50 patients with pterygium treated in our hospital from April 2016 to January 2017 were selected including 81 eyes.They were divided into two groups by random number table method，and the observation group including 40 eyes and they were treated with simple pterygium excision combined with conjunctival autograft with limbal stem cells surgery while the control group including 41 eyes，and they were treated with simple pterygium excision.The efficacy between the two groups were compared.Results The BUT in after 1 and 3 months operation in the two groups had no statistically difference compared with before operation （P<0.05）.The BUT in the control group was shorter than that before operation after 5 days operation，and there was a statistically difference （P<0.05）.After 5 days operation，the BUT between the two groups had a significant difference （P<0.05）.The t-HOA after 1，3 months operation were significantly lower than that before operation （P<0.05）.The proportion of Ⅲ-Ⅳ grade of the observation group was lower than that of the control group （5.0% vs. 21.9%）（P<0.05）.Conclusion Simple pterygium excision combined with limbal autograft conjunctival flap transplantation operation has a reliable effect，and it helps to improve the visual quality.

[Key words]Pterygium excision；Limbal stem cell transplantation surgery；Ocular surface；Pterygium

傳统的翼状胬肉切除术由于术后复发率高，导致手术效果并不满意，临床医师不得不考虑术后长期应用激素类药物以降低疾病术后复发率[1-2]。但是研究发现，即使在术后应用激素类等药物治疗，患者复发率扔很高，可高达9.5%～30%[3]。角膜缘移植术是指将自体健侧角膜缘结膜片移植到患处的角膜受损区域，从根本上修复病变部位，可减少病变复发。为进一步了解角膜缘干细胞移植术对患者的影响[4]。本研究探讨翼状胬肉切除术联合角膜缘干细胞移植术治疗翼状胬肉的效果，现报道如下。

1资料与方法

1.1一般资料

选取2016年4月～2017年1月在我院进行治疗的翼状胬肉患者50例，其中男22例，女28例，年龄40～68岁，平均（60.24±5.17）岁。50人共检查出81只眼，单眼19例，双眼31例，左眼42只，右眼39只。根据随机数字表法将患者分为两组，观察组共40眼，男12例，女14例，年龄40～66岁，平均（58.6±4.8）岁；对照组共41眼，男10例，女14例，年龄41～68岁，平均（60.1±5.1）岁。……