摘要
目的评估翼状胬肉广泛切除联合羊膜移植或/和丝裂霉素C应用的有效性和安全性。方法回顾性研究笔者采用联合手术治疗的连续性的翼状胬肉患者共259例(297眼),其中原发性胬肉193例(227眼),复发性胬肉66例(70眼)。按原发性或复发性翼状胬肉和手术方式共分6组:原发性胬肉分为:A组(对照组)单纯广泛切除35例(42眼);B组广泛切除+丝裂霉素C(MMC)26例(30眼);C组广泛切除+羊膜移植(AMT)90例(105眼);D组广泛切除+MMC+AMT 42例(50眼)。复发性胬肉分为:E组广泛切除+AMT 40例(43眼);F组广泛切除+MMC+AMT 26例(27眼)。追踪观察最短1年,最长8年。结果①复发率:A组10眼复发(23.8%),B组3眼复发(10.0%),C组7眼复发(6.7%),D组2眼复发(4.0%),E组6眼复发(13.9%),F组3眼复发(11.1%)。A组与C组(2=10.38,p<0.01),A组与D组(2=8.68,p<0.01),差异有显著统计学意义。其余各组之间的差异均无统计学意义。②并发症:睑球粘连1眼;全部联合应用MMC的病例中巩膜缺血改变(较苍白)9眼,未发现角膜溃疡、巩膜溶解与溃疡、虹膜炎与眼内炎等严重并发症。③术后视力:比术前视力提高1～2行者86眼(29%),提高3行以上者80眼(26.9%),与术前视力相同者121眼(40.7%),视力下降者10眼(3.4%)。结论翼状胬肉广泛切除联合羊膜移植和术中应用丝裂霉素C或单独联合羊膜移植能有效地降低原发性胬肉术后复发率,对阻止复发性胬肉术后再复发同样有效;原发性胬肉切除联合应用丝裂霉素C也有一定的阻止复发作用;翼状胬肉切除联合术中应用丝裂霉素C安全有效。
Objective To evaluate the effect and safety of extensive pterygium excision combined with amni- otic membrane transplantation and/or use of mitomycin C in treating pterygium. Methods A retrospective study was done in 297 eyes of 259 patients with pterygium. 227 eyes in 193 cases suffered with primary pterygium, and 70 eyes in 66 cases suffered with recurrent pterygium. According to operative style, the treated cases were divided into 6 groups. Group A （ simple extensive excision of primary pterygium） 35 cases （42 eyes） ; Group B （ primary pterygium excision combined with intraoperative mitomycin, MMC） 26 cases （30 eyes） ; Group C （primary pterygium excision combined with anmiotic membrane transplantation, AMT） 90 cases （105 eyes） ;Group D（ primary pterygium exci- sion combined with AMT plus MMC ） 42eases （ 50 eyes） ; Group E （ recurrent pterygium excision combined with AMT） 40 cases （43 eyes） ; Group F （recurrent pterygium excision combined with AMT and MMC） 26 cases （27 eyes）. The follow up periods were 1 year to 8 years. Results The respective recurrence rate in group A through F was 23.8%, 10.0%, 6.7%, 4.0%, 13.9% and 11.1%. Between Group A and group C, Group A and group D, differences were significant obvious （p 〈 0. 01 ）. The recurrence rate between any other groups was no significant difference （p 〉 0. 05）. No severe complications were encountered in every group. Conclusion Pterygium extensive excision combined with AMT and intraoperative 0.02% MMC for 5 minute or excision combined with AMT alone can reduce the recurrent rate after primary pterygium and recurrent pterygium surgery. Primary pterygium simple excision plus intraoperative MMC is effective too. Pterygium extensive excision plus intraoperative MMC and/or AMT were sa- fer and effective.
出处
《现代医院》
2013年第6期30-33,共4页
Modern Hospitals
基金
广州市荔湾区科技计划项目(编号:20121214203)
