结膜瓣遮盖手术在难治性角膜疾病治疗中的作用评价

发布时间：2018-01-14 05:13

本文关键词：结膜瓣遮盖手术在难治性角膜疾病治疗中的作用评价　出处：《第三军医大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:评价结膜瓣遮盖术在各种类型难治性角膜疾病治疗中的疗效。方法:采用回顾性分析的方法,对第三军医大学西南医院眼科2001-2014年住院和采用结膜瓣遮盖手术治疗的各种类型难治性角膜疾病患者161例(161只眼)进行分析,161例患者均为经过针对性药物治疗无效或病情加重者。其中,感染性角膜溃疡118例,非感染性角膜疾病43例。前者包括真菌性角膜溃疡71例,细菌性角膜溃疡16例,单纯疱疹病毒性角膜溃疡31例。后者包括大泡性角膜病变22例,神经麻痹性角膜溃疡6例,角膜移植片溃疡10例,角膜异物取出后穿孔或接近穿孔5例。所有患者均由同一术者行桥式结膜瓣遮盖手术。术后依据原发病继续使用药物治疗。随访3~106个月,观察临床疗效。结果:161例患者中,共治愈141例,治愈率87.6%。其中,感染性角膜溃疡(包括真菌性、细菌性、单纯疱疹病毒性角膜溃疡)118例中,共治愈99例,治愈率83.9%。真菌性角膜溃疡治愈54例(54/71),治愈率76.1%;细菌性角膜溃疡治愈15例(15/16),治愈率93.8%;单纯疱疹病毒性角膜溃疡治愈30例(30/31),治愈率96.8%。非感染性角膜疾病43例中,治愈42例,治愈率97.7%。大泡性角膜病变治愈21例(21/22),治愈率为95.5%;神经麻痹性角膜溃疡治愈6例(6/6),治愈率为100%;角膜移植片溃疡治愈10例(10/10),治愈率为100%;角膜异物取出后穿孔或接近穿孔治愈5例,(5/5)治愈率为100%。感染性角膜溃疡的治愈率与非感染性角膜疾病的治愈率相比差异有统计学差异(P0.05),非感染性角膜疾病的治愈率明显高于感染性角膜疾病。在感染性角膜疾病中,非急性化脓性角膜溃疡(单纯疱疹病毒性角膜溃疡)的治疗效果优于急性化脓性角膜溃疡(真菌、细菌)(P0.05)。共发生21例(21只眼)手术并发症,其中结膜瓣部分溶解11例,结膜瓣穿孔4例,结膜瓣滑脱4例,继发青光眼2例。感染性角膜疾病中,手术后发生并发症20例,发生率16.9%,非感染性角膜疾病手术后并发症1例,发生率2.3%,两者并发症发生率比较,差异有统计学意义(P0.05),非感染性角膜疾病手术并发症的发生率明显低于感染性角膜疾病。结论:结膜瓣遮盖手术对各种类型的难治性角膜疾病治疗效果显著,对非感染性角膜病变的疗效优于感染性角膜病。对于急性化脓性角膜溃疡,手术前进行针对性治疗可能有助于提高手术的成功率。
[Abstract]:Objective: to evaluate the efficacy of conjunctival flap covering in the treatment of various types of refractory corneal diseases. A total of 161 patients with various types of refractory corneal diseases (161 eyes) admitted to the Southwest Hospital of the third military Medical University from 2001 to 2014 and treated with conjunctival flap covering surgery were analyzed. 161 cases were all ineffective or aggravated by targeted drug therapy, including 118 cases of infective corneal ulcer and 43 cases of non-infectious corneal disease. The former included 71 cases of fungal corneal ulcer. There were 16 bacterial corneal ulcers and 31 herpes simplex corneal ulcers, including 22 cases of vesicular keratopathy, 6 cases of nerve paralysis corneal ulcers and 10 cases of corneal allograft ulcers. There were 5 cases of corneal foreign body perforation or near perforation after removal. All the patients were covered by bridge conjunctival flap in the same operation. After operation, the patients were treated with drugs according to the primary disease. The follow-up period was 3 ~ 106 months. Results 141 cases were cured, and the cure rate was 87.6%. Among them, infectious corneal ulcer (including fungal and bacterial). In 118 cases of herpes simplex virus corneal ulcer, 99 cases were cured, the cure rate was 83.9%. 54 cases of fungal corneal ulcer were cured, the cure rate was 76. 1%. 15 cases of bacterial corneal ulcer were cured, and the cure rate was 93.8%. 30 cases of herpes simplex virus corneal ulcer were cured, the cure rate was 96. 8%. Of 43 cases of non infectious corneal diseases, 42 cases were cured. The cure rate was 97.70.21 cases of Bubular keratopathy were cured, and the cure rate was 95.5%. Nerve paralysis corneal ulcer was cured in 6 cases (6 / 6), and the cure rate was 100%. The corneal allograft ulcer was cured in 10 cases (10 / 10) and the cure rate was 100%. 5 cases were cured after corneal foreign body was removed and perforated or nearly perforated. The cure rate of infectious corneal ulcer was 100. The cure rate of infectious corneal ulcer was significantly different from that of non-infectious corneal disease (P 0.05). The cure rate of noninfectious corneal diseases was significantly higher than that of infectious corneal diseases. The therapeutic effect of non-acute suppurative corneal ulcer (herpes simplex corneal ulcer) is better than that of acute suppurative corneal ulcer (fungi). Complications occurred in 21 cases (21 eyes), including 11 cases of partial dissolution of conjunctival flap, 4 cases of perforation of conjunctival flap and 4 cases of slippage of conjunctival flap. Complications occurred in 20 cases (16.9%) after operation and 1 case (2.3%) after operation for non-infectious corneal diseases. There was significant difference in the incidence of complications between the two groups (P 0.05). The incidence of complications in non-infectious corneal diseases was significantly lower than that in infectious corneal diseases. Conclusion: conjunctival flap covering surgery is effective in the treatment of various types of refractory corneal diseases. The therapeutic effect of noninfectious keratopathy is better than that of infective keratopathy. For acute suppurative corneal ulcer, targeted treatment before operation may help to improve the success rate of operation.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R779.6

【相似文献】