翼状胬肉切除联合自体结膜瓣反转移植术治疗翼状胬肉的临床研究

发布时间：2018-03-10 18:45

  本文选题：翼状胬肉　切入点：手术治疗　出处：《山东大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究背景：翼状胬肉指的是局部的眼球球结膜和其下生成的纤维血管组织不断增生,而且增生为三角形并膜样。这种疾病会逐渐侵犯眼球,并且是慢性的眼表疾病,它的形状通常呈像昆虫的翅膀,因此多数情况下会被称为“胬肉攀睛”或“攀睛”。迄今为止翼状胬肉的具体发病原因仍然尚不明了,有学者认为可能与紫外线照射、接触风尘等方面有一定的关系。翼状胬肉发展呈进行性增大,由于对角膜的牵拉作用会引起角膜的屈光状态改变,逐渐中心视力可受累,重者可严重影响视力,影响美观。目前公认的对翼状胬肉的治疗方法是手术切除。但是一些传统早期的单纯胬肉切除术的手术术后复发率很高。近几年由于手术方式的不断改良,为该病的临床治疗提供了很多崭新的治疗途径。近期我科探索出一种新的手术方式——翼状胬肉切除术联合结膜瓣反转移植术。本研究拟比较自体结膜瓣反转移植术与翼状胬肉单纯切除术及翼状胬肉切除联合干细胞移植术手术效果,以评估此种手术方式的可行性及临床疗效。研究方法：收集2014年8月至2015年4月在山东大学齐鲁医院眼科就诊的61例(76只眼)静止期翼状胬肉患者(其中6例为复发性翼状胬肉),随机分为三组,分别采用翼状胬肉单纯切除术(A组23眼)、翼状胬肉切除联合干细胞移植术(B组28眼)和翼状胬肉切除联合结膜瓣反转移植术(C组25眼),以角膜上皮术后恢复良好,可见光滑透明的角膜表面,且无明显的新生血管和真性翼状胬肉样组织增生为治愈；以Prabhasawat分期4期(结膜充血明显,手术区有新生血管和真性胬肉发生)视为复发。术后随访1年,分别在术后1、2week及1、2、3、4、6、12month复查,常规行裂隙灯检查,患者视力及屈光度数检查,从而比较三组患者术后效果。研究结果：数据采用t检验及两样本率比较的U检验等进行统计学处理。本研究共纳入翼状胬肉患者61例(76眼),其中男性32例(39只眼),女性29例(37只眼),年龄44-75岁,平均(60+10.7)岁,病程1-30年,平均(9.5+7.6)年,胬肉侵入角膜缘距离1～6mm,平均(3.42+1.45)mm。随机将其分为A、B、C三组。翼状胬肉单纯切除术组(A组)复发6眼,复发率为26.1%,与其它两组比较差异有显著统计学意义(P0.05),翼状胬肉切除联合干细胞移植术组(B组)复发2眼,复发率为7.1%,翼状胬肉切除联合结膜瓣反转移植术组(C组)复发1眼,复发率为4%,且B、C两组比较差异无统计学意义(P0.05)。三组术前、术后裸眼视力及散光度数差异均有显著统计学意义(P0.05),。B、C两组术后1周内,出现植片充血水肿,充血时间为3-16天,平均8.82±4.62天,C组充血时间为3-21天,平均(10.56±6.14)天,两组比较差异无统计学意义(P0.05),患者可有轻度畏光、流泪等不适。三组术后角膜表面逐渐光滑透明,A组角膜创面愈合时间为3～7天,平均(4.72±0.12)天,B组为2～6天,平均(3.27±0.96)天,C组为2-6天,平均(3.73±9.15)天。三组结果差异无统计学意义(P0.05)。A组1周拆除结膜缝线,B、C两组视恢复情况术后1～2周拆线,眼刺激症状逐渐减轻至消失。B组拆线时间为7～20天,平均(15.13±3.68)；C组拆线时间为7-28天,平均(14.24±4.91)天。B组结膜瓣愈合时间为14～35天。平均(18.78±8.62)天；C组为21～68天,平均(35.08+13.37)天,两组结果比较差异有显著性差异(P0.01)。研究结论：翼状胬肉切除联合自体结膜瓣反转移植术可有效治疗翼状胬肉,减小翼状胬肉角膜散光,从而改善视功能,且无严重并发症,是一种新型且有效的手术方式,但同时需要术者在手术过程中对结膜瓣的处理恰当而严谨,才能保证较低的术后复发率和避免更多并发症的出现。
[Abstract]:Background: pterygium refers to eye conjunctival fibrovascular tissue generated locally and under the continuous proliferation and hyperplasia of triangular and membranous. The disease will gradually invaded eyeball, and chronic ocular surface disease, its shape is usually like the wings of an insect, so in most cases will be referred to "pterygium" or "crassum". So far the specific pathogenesis of pterygium still remains unclear, some scholars believe that may be related to ultraviolet radiation, there is a certain relationship between the contact dust and so on. Development of pterygium were increased due to corneal traction can cause corneal refractive changes gradually, central vision can be affected, they can seriously affect vision, affect the appearance of pterygium. Currently accepted treatment is surgical resection. But traditional early simple excision of pterygium hand The postoperative recurrence rate is very high. In recent years, due to the continuous improvement of surgical methods, provides a lot of new therapeutic approaches for the clinical treatment of the disease. Recently I, explore a new surgical method of pterygium excision combined with conjunctival flap transplantation. The anti transfer of this study was to compare the autogenous conjunctival flap anti metastasis transplantation and simple pterygium excision and excision of pterygium combined with stem cell transplantation surgery, the feasibility and clinical effect of surgical evaluation. The research methods: collected from August 2014 to April 2015 in Qilu Hospital of Shandong University on the diagnosis of 61 cases (76 eyes) quiescent pterygium patients (including 6 cases of recurrence pterygium), were randomly divided into three groups, respectively, using simple pterygium resection (group A, 23 eyes) of pterygium excision combined with stem cell transplantation (group B, 28 eyes) and pterygium excision combined with conjunctival flap Reverse transplantation (group C, 25 eyes) with corneal epithelium recovered well after operation, visible corneal surface smooth and transparent, and there is no obvious neovascularization and true pterygium tissue hyperplasia was cured; in Prabhasawat stage 4 (conjunctival congestion significantly, surgical area and neovascularization occurred as recurrent pterygium vera). Postoperative follow-up of 1 years, after the operation. 1,2week and 1,2,3,4,6,12month were underwent slit lamp examination, visual acuity and diopter check, in order to compare the three groups of patients with postoperative results. Results: compared with the data rate of t test and two sample U test was used for statistical analysis. 61 cases were included in this study pterygium patients (76 eyes), including 32 male patients (39 eyes), female 29 cases (37 eyes), aged 44-75, average (60+10.7), duration of 1-30 years, the average (9.5+7.6), pterygium from 1 ~ 6mm, average (3.42+1.45) with mm. 鏈哄皢鍏跺垎涓篈,B,C涓夌粍.缈肩姸鑳�鑲夊崟绾�鍒囬櫎鏈�缁�(A缁，

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