[1]张　键,柏丽娜,王晓莉,等.不同手术移植方式联合胬肉切除治疗原发性翼状胬肉临床效果比较[J].新乡医学院学报,2022,39(8):760-766.[doi:10.7683/xxyxyxb.2022.08.012]
　ZHANG Jian,BAI Lina,WANG Xiaoli,et al.Comparison of clinical effects of different surgical transplantation methods combined with pterygium excision in the treatment of primary pterygium[J].Journal of Xinxiang Medical University,2022,39(8):760-766.[doi:10.7683/xxyxyxb.2022.08.012]
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不同手术移植方式联合胬肉切除治疗原发性翼状胬肉临床效果比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年8
页码:
760-766
栏目:
临床研究
出版日期:
2022-08-05

文章信息/Info

Title:
Comparison of clinical effects of different surgical transplantation methods combined with pterygium excision in the treatment of primary pterygium
作者:
张　键1; 柏丽娜1; 王晓莉1; 蔡方荣1; 陈雍华2
(1.简阳市人民医院/西南医科大学附属简阳医院眼科，四川　简阳　641400；2.陆军军医大学西南医院护理部，重庆　400038）
Author(s):
ZHANG Jian1; BAI Lina1; WANG Xiaoli1; CAI Fangrong1; CHEN Yonghua2
（1.Department of Ophthalmology,People′s Hospital of Jianyang City,Jianyang Hospital Affiliated to Southwest Medical University,Jianyang 641400,Sichuan Province，China;2.Department of Nursing,Southwest Hospital of the Army Medical University,Chongqing 400038,China)
关键词:
翼状胬肉; 角膜缘干细胞移植; 结膜瓣移植; 羊膜移植
Keywords:
pterygium; limbal stem cell transplantation; conjunctival flap transplantation; amniotic membrane transplantation
分类号:
R772.2
DOI:
10.7683/xxyxyxb.2022.08.012
文献标志码:
A
摘要:
目的　比较3种不同的手术移植方式联合胬肉切除治疗原发性翼状胬肉的临床效果。方法　选择2017年12月至2020年12月简阳市人民医院收治的132例原发性翼状胬肉患者为研究对象，按手术移植方式将患者分为角膜缘干细胞移植组(n=44)、结膜瓣移植组(n=46)和羊膜移植组(n=42)，角膜缘干细胞移植组患者给予胬肉切除联合角膜缘干细胞移植术治疗，结膜瓣移植组患者给予胬肉切除联合结膜瓣移植术治疗，羊膜移植组患者给予胬肉切除联合羊膜移植术治疗。观察记录3组患者术后眼部刺激症状消失时间、移植物愈合时间、术后6个月内并发症及胬肉复发情况。术前及术后6个月分别测定患者裸眼视力、屈光度、泪液分泌长度(SIt)、泪膜破裂时间(BUT)、角膜荧光素染色(CFS)评分、结膜杯状细胞数量、眼表疾病指数(OSDI)。结果　角膜缘干细胞移植组和结膜瓣移植组患者术后眼部刺激症状消失时间、移植物愈合时间均显著短于羊膜移植组(P<0.05)；角膜缘干细胞移植组与结膜瓣移植组患者的术后眼部刺激症状消失时间、移植物愈合时间比较差异无统计学意义(P﹥0.05)。3组患者术前裸眼视力、屈光度、SIt、BUT、OSDI评分、CFS评分、结膜杯状细胞数量比较差异无统计学意义(F=0.926、0.884、0.137、0.104、0.182、0.325、0.692，P>0.05)。术后6个月，3组患者的裸眼视力、SIt、BUT、结膜杯状细胞数量均较术前显著提高（P<0.05），屈光度、OSDI评分、CFS评分均较术前显著降低（P<0.05）；术后6个月，角膜缘干细胞移植组、结膜瓣移植组患者的裸眼视力、SIt、BUT、结膜杯状细胞数量显著高于羊膜移植组（P<0.05），屈光度、OSDI评分、CFS评分显著低于羊膜移植组(P<0.05)；术后6个月，角膜缘干细胞移植组与结膜瓣移植组患者的裸眼视力、屈光度、SIt、BUT、OSDI评分、CFS评分、结膜杯状细胞数量比较差异无统计学意义(P>0.05)。 术后6个月，角膜缘干细胞移植组患者发生眼部刺激感2例(4.55%)，结膜肉芽肿1例（2.27%），并发症发生率为6.82%（3/44）；结膜瓣移植组患者发生眼部刺激感2例(4.35%)，结膜肉芽肿1例（2.17%），并发症发生率为 6.52 %(3/46)；羊膜移植组患者发生眼部刺激感3例(7.14%)，结膜肉芽肿2例（4.76%），植入性囊肿1例（2.38%），并发症发生率为 14.28 %(6/42)；角膜缘干细胞移植组、结膜瓣移植组患者的并发症发生率低于羊膜移植组（χ2=7.523、 7.541，P<0.01)，角膜缘干细胞移植组与结膜瓣移植组患者的并发症发生率比较差异无统计学意义（χ2=0.327，P>0.05)。角膜缘干细胞移植组患者无复发，结膜瓣移植组患者复发2例（4.35%），羊膜移植组患者复发3例（7.14%）；角膜缘干细胞移植组、结膜瓣移植组患者的复发率低于羊膜移植组（χ2=6.327、7.106，P<0.05)，角膜缘干细胞移植组患者复发率低于结膜瓣移植组（χ2=6.048，P<0.05)。结论　胬肉切除联合角膜缘干细胞移植、结膜瓣移植或羊膜移植对翼状胬肉均有较好的治疗效果，但角膜缘干细胞移植术和结膜瓣移植术的治疗效果优于羊膜移植术，且角膜缘干细胞移植术后复发率和并发症发生率最低，综合治疗效果最佳，眼部功能恢复效果最好，胬肉切除联合角膜缘干细胞移植可作为翼状胬肉临床治疗的最佳术式。
Abstract:
Objective　To compare the clinical effects of three different surgical transplantation methods combined with pterygium excision in the treatment of primary pterygium.Methods　A total of 132 patients with primary pterygium admitted to Jianyang People′s Hospital from December 2017 to December 2020 were selected as the research objects,and the patients were divided into limbal stem cell transplantation group (n=44),conjunctival flap transplantation group (n=46) and amniotic membrane transplantation group (n=42) according to the surgical transplantation methods.The patients in the limbal stem cell transplantation group were treated with pterygium excision combined with limbal stem cell transplantation,the patients in the conjunctival flap transplantation group were treated with pterygium excision combined with conjunctival flap transplantation,and the patients in the amniotic membrane transplantation group were treated with pterygium excision combined with amniotic membrane transplantation.The disappearance time of ocular irritation symptoms,graft healing time,complications and pterygium recurrence within 6 months after operation were compared among the three groups.The naked eye vision,diopter,tear secretion length (SIt),tear film break-up time (BUT),corneal fluorescein staining (CFS) score,the number of conjunctival goblet cells,and ocular surface disease index (OSDI) were measured before and 6 months after operation.Results　The disappearance time of ocular irritation symptoms and graft healing time of patients in the limbal stem cell transplantation group and conjunctival flap transplantation group were significantly shorter than those in the amniotic membrane transplantation group (P<0.05);there was no significant difference in the disappearance time of ocular irritation symptoms and graft healing time of patients between the limbal stem cell transplantation group and conjunctival flap transplantation group (P>0.05).There was no significant difference in the naked eye vision,diopter,SIt,BUT,OSDI score,CFS score and the number of conjunctival goblet cells of patients among the three groups before operation (F=0.926,0.884,0.137,0.104,0.182,0.325,0.692;P>0.05).At six months after operation,the naked eye vision,SIt,BUT and the number of conjunctival goblet cells of patients were significantly higher than those before operation (P<0.05),and the diopter,OSDI score and CFS score of patients were significantly lower than those before operation in the three groups (P<0.05).At six months after operation,the naked eye vision,SIt,BUT and the number of conjunctival goblet cells of patients in the limbal stem cell transplantation group and conjunctival transplantation group were significantly higher than those in the amniotic membrane transplantation group (P<0.05);and the diopter,OSDI score and CFS score were significantly lower than those in the amniotic membrane transplantation group (P<0.05).At six months after operation,there was no significant difference in naked eye vision,diopter,SIt,BUT,OSDI score,CFS score and the number of conjunctival goblet cells of patients between the limbal stem cell transplantation group and conjunctival flap transplantation group (P>0.05).At six months after operation,in the stem cell transplantation group,2 cases (4.55%) had ocular irritation,1 case (2.27%) had conjunctival granuloma,and the incidence of complications was 6.82%（3/44）;in the conjunctival flap transplantation group,2 cases (4.35%) had eye irritation occurred,1 case (2.17%) had conjunctival granuloma,and the incidence of complications was 6.52%(3/46);in the amniotic membrane transplantation group,3 cases (7.14%) had eye irritation,2 cases (4.76%) had conjunctival granuloma,1 case (2.38%) had implanted cyst,and the incidence of complications was 14.28%(6/42).The incidence of complications of patients in the stem cell transplantation group and conjunctival transplantation group was lower than that in the amniotic membrane transplantation group (χ2=7.523，7.541；P<0.01),and there was no significant difference in the incidence of complications of patients between the stem cell transplantation group and the conjunctival transplantation group (χ2=0.327,P>0.05).There was no recurrence in the stem cell transplantation group,2 cases (4.35%) of recurrence in the conjunctival flap transplantation group and 3 cases (7.14%) of recurrence in the amniotic membrane transplantation group.The recurrence rate in the stem cell transplantation group and conjunctival transplantation group was lower than that in the amniotic membrane transplantation group (χ2=6.327,7.106;P<0.05),and the recurrence rate in the stem cell transplantation group was lower than that in the conjunctival transplantation group (χ2=6.048,P<0.05).Conclusion　　Pterygium excision combined with limbal stem cell transplantation,conjunctival flap transplantation or amniotic membrane transplantation all has good therapeutic effect on primary pterygium.The therapeutic effect of limbal stem cell transplantation and conjunctival flap transplantation is better than that of amniotic membrane transplantation,and the rates of recurrence and complications of patients underwent limbal stem cell transplantation are lowest,the effect of eye function recovery and the comprehensive treatment effect of the patients is the best,limbal stem cell transplantation combined with pterygium excision can be used as the best surgical method for clinical treatment of pterygium.

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[1]杨延芳,刘朝,宫晓红.翼状胬肉切除联合丝裂霉素预防复发临床观察[J].新乡医学院学报,2000,17(03):217.
[2]宋慧洋,朱秋建,李　斌,等.医用生物蛋白胶联合自体结膜移植及治疗性接触镜配戴治疗单纯翼状胬肉[J].新乡医学院学报,2015,32(12):1125.

更新日期/Last Update: 2022-08-05