部分结膜切除术治疗结膜松弛症性溢泪的疗效

目的：评价球结膜部分切除术治疗球结膜松弛症患者溢泪的安全性和有效性。方法：回顾性病例系列研究。对2015年6月到2017年12月在陆军军医大学附属西南医院眼科确诊为结膜松弛症并伴有溢泪症状，接受部分结膜切除手术治疗的患者31例（31眼），完成随访的27例（27眼）进行统计分析。所有患者的结膜松弛症均为Ⅲ级或以上，接受球结膜部分切除术后，检查患者自觉症状及结膜脱垂体征变化。采用配对t检验比较术前及术后1、6、12个月泪膜破裂时间变化以及术前和术后6个月的下泪河高度变化。结果：术后患者的溢泪症状均消失。拆除结膜缝线后未见切口处的结膜裂开。至术后平均15个月的随访期间，裂隙灯显微镜检查未见结膜松弛症复发。术后随访各时间点泪膜破裂时间均显著提高（P<0.001），术后12个月下泪河高度较术前提高（t=-14.642，P<0.001）。结论：切除松弛脱垂的球结膜，间断缝合球结膜切口，并固定于浅层巩膜上，可有效避免手术中结膜撕裂和术后结膜切口裂开等手术并发症，能够改善患者的溢泪，一定程度上稳定泪膜，且安全、有效。

An Evaluation of Partial Conjunctival Resection for Conjunctivochalasis

Objective: To evaluate the safety and surgical efficacy of epiphora caused by conjunctivochalasis that includes surgical removal of the excess conjunctiva. Methods: This was a retrospective case series study. From June 2015 to December 2017, 31 patients (31 eyes) who were diagnosed with conjunctivochalasis underwent partial conjunctival resection in the Department of Ophthalmology, Southwest Hospital, Army Military Medical University. All patients had grade III and above conjunctival relaxation. After partial conjunctival resection, the patients were examined for changes in their symptoms and signs of conjunctival prolapse as well as tear break-up time (BUT) and tear meniscus. The changes in BUT were compared before surgery and after surgery at 1 month, 6 months and 12 months, and changes in tear meniscus were compared before surgery and after surgery at 6 months by paired t test. Results: After the operation, the patients' epiphora disappeared. No conjunctival epiphora was observed when the conjunctival suture was removed. There was no recurrence of conjunctivochalasis based on slit lamp examination during the follow-up period of 12 months to 17 months after surgery. Tear break-up time significantly increased at each time point after surgery (P<0.001), and the tear meniscus was higher than it was before surgery(P<0.001). Conclusions: Surgical removal of excess conjunctiva is safe and is an effective way for correcting epiphora caused by conjunctivochalasis. The free conjunctival edges were sutured and the sutures passed through the superficial sclera. This procedure can effectively avoid incision dehiscence and suture-related complications. This surgical method is a worth while clinical procedure.