纤维蛋白胶在翼状胬肉切除联合自体角膜缘干细胞移植术中的应用研究

目的探讨纤维蛋白胶固定球结膜移植片的效果和安全性。方法采用前瞻性随机对照的方法。对40例原发忡鼻侧翼状胬肉行翼状胬肉切除联合自体角膜缘干细胞移植术,术中分别采用纤维蛋白胶（20例,20眼）和10-0尼龙缝线（20例,20眼）同定球结膜移植片,术后随访6个月。．结果两组手术移植的球结膜瓣均成功固定于巩膜表面,并全部成活。纤维蛋门胶组患者平均手术时间（20．5±3．6）rain,104）尼龙缝线组平均手术时问（42．8±4．5）min（P〈0．01）。术后纤维蛋白胶组患者疼痛、异物感、畏光、流泪症状比缝线组轻并消失较快（P〈0．01）。随访期间两组均无复发。结论翼状胬肉切除后使用纤维蛋白胶牯贴同定自体球结膜瓣是一种安全、有效的方法。     

纤维蛋白胶联合绷带型角膜接触镜在翼状胬肉切除术中的应用

目的：探讨应用纤维蛋白胶联合绷带型角膜接触镜减轻翼状胬肉切除联合自体角膜缘干细胞移植术后疼痛的效果。 方法：对52例72眼行翼状胬肉切除联合自体角膜缘干细胞移植手术治疗的初发性翼状胬肉患者,随机分为试验组（纤维蛋白胶联合绷带型角膜接触镜组）28例38眼和对照组（缝线组）24例34眼。试验组及对照组给予常规20 g/L利多卡因浸润麻醉后进行翼状胬肉切除联合自体角膜缘干细胞移植术。试验组采用黏合剂将植片与植床进行粘贴,对照组采用10-0缝线缝合植片与植床。术毕,试验组角膜表面放置角膜接触镜,对照组不配戴角膜接触镜。主要术后观察患者的术后1,2,3,5,7 d疼痛评分。术后随访6mo,观察植床与植片的匹配程度及感染、复发、植片愈合不良、结膜下囊肿等并发症情况。 结果：试验组患者疼痛程度评分均较对照组显著降低（均为P=0.000）。观察期内,两组植床与植片均成功固定于巩膜表面,并全部成活,同时两组患者均未发生感染、复发、植片愈合不良、结膜下囊肿等并发症。 结论：联合运用纤维蛋白胶黏合剂粘及角膜接触镜,可明显减轻翼状胬肉术后的疼痛反应。     

纤维蛋白胶运用于翼状胬肉手术的临床观察

目的:观察纤维蛋白胶运用于翼状胬肉切除联合自体结膜移植术的临床效果。方法:选取60例60眼原发性鼻侧翼状胬肉患者随机分为试验组(纤维蛋白胶组)和对照组(缝线组)各30例30眼。行翼状胬肉切除联合自体结膜移植术,试验组采用纤维蛋白胶粘合固定植片,对照组采用10-0尼龙线缝合固定植片。术后随访6mo,观察手术时间、术后疼痛、异物感、并发症以及复发。结果:试验组手术时间(24.5±6.5min)较对照组(35.2±5.4min)短,两组差异有统计学意义(P<0.05)。术后患者疼痛和异物感试验组较对照组减轻(P<0.05)。两组均未发生术后严重并发症,试验组结膜下出血发生率低于控制组(P<0.05),6mo时纤维蛋白胶组1例(3%)复发,缝线组3例(10%)复发。结论:纤维蛋白胶运用于翼状胬肉手术固定结膜植片能减轻患者术后不适,减少手术时间及术后并发症,是一种安全有效的方法。     

纤维蛋白胶在翼状胬肉切除联合自体角膜缘干细胞移植术中的临床效果

目的:探讨应用纤维蛋白胶在胬肉切除联合自体角膜缘干细胞移植术中的效果。方法:对48例60眼行胬肉切除联合自体角膜缘干细胞移植手术治疗的初发性翼状胬肉患者,随机分为试验组(纤维蛋白胶组)22例30眼和对照组(缝线组)26例30眼。实验组及对照组给予常规20g/L利多卡因浸润麻醉后进行胬肉切除联合自体角膜缘干细胞移植术;试验组采用黏合剂将植片与植床进行粘贴(黏合剂为凝血酶溶液及含有因子Ⅷ和抑肽酶的纤维蛋白溶液),对照组采用10-0缝线缝合植片与植床。术后随访6mo,主要观察手术时间,植床与植片的匹配程度及术中与术后患者的疼痛评分。结果:试验组手术时间相对较短,差异有统计学意义(P<0.01),试验组植床与植片匹配度与对照组无明显差异(P<0.05),术后1wk内患者生活质量试验组优于对照组。结论:纤维蛋白胶黏合剂完全能满足胬肉切除联合自体角膜缘干细胞移植术的要求,且能清晰地切除病变组织并使植床与植片很好匹配,缩短了手术时间,减少了患者的痛苦。     

纤维蛋白胶在翼状胬肉切除联合无缝线羊膜移植术中应用的临床观察

目的 观察与探讨纤维蛋白胶在翼状胬肉切除联合羊膜移植术中应用的方式方法和临床效果.方法 筛选原发性翼状胬肉患者21人(26只眼),行胬肉切除联合羊膜移植术.所有患者随机分为无缝线组及缝线组:无缝线组11人(13只眼),术中将胬肉组织切除后,采用纤维蛋白胶黏合固定羊膜植片;缝线组10人(13只眼),以10-0尼龙缝线间断缝合固定羊膜植片.术后随访6个月,记录手术时间、术后症状和体征.并应用SPSS统计软件对两组结果进行分析.结果 无缝线组手术时间(13.6±3.5)min明显短于缝线组(22.3±5.2)rain(P<0.01).术后2周内(拆线前),无缝线组术眼疼痛、异物感和流泪等局部刺激症状均显著轻于缝线组(P<0.01).两组术后均未发生植片移位并发症.无缝线组术后羊膜植片贴附紧密,均于术后1周内迅速上皮化.缝线组术后有5只眼(38.5%)发生羊膜下积液,羊膜上皮化较无缝线组略迟,于术后8～ 10d完全上皮化.无缝线组羊膜愈合良好,局部无明显瘢痕发生;缝线组均出现不同程度的缝线刺激性瘢痕.术后6个月随访期内两组均未见胬肉复发.结论 在翼状胬肉切除联合羊膜移植术中使用纤维蛋白胶可替代手术缝线,使用方便,并明显缩短手术时间,减轻术后刺激症状,并利于羊膜愈合、减轻局部瘢痕,达到更好的美容目的 .     

纤维蛋白胶和缝线固定两种方法在翼状胬肉手术中的比较

目的:在翼状胬肉切除联合自体角膜缘移植手术中,比较运用纤维蛋白胶和缝线固定两种方法的手术安全性和有效性。方法:采用前瞻性的研究。随机选取58例因鼻侧初发性翼状胬肉而进行手术的58只患眼。翼状胬肉切除后取位于颞上侧角膜缘处的自体结膜移植片以覆盖巩膜创口。58例眼分为两组,每组29例。翼状胬肉切除后,组1用纤维蛋白胶(Beriplast P)固定结膜,而组2采用8-0缝线固定结膜。术后观察患者≥6mo,对术后患者的不适感(疼痛、刺痛感、流泪)和显微镜下的检查(充血、水肿)进行评分,采用Mann-Whitney U法对两组间的差异进行统计学分析。结果:组1中有1例患者出现球结膜下出血,组2中有7例由于肉芽肿反应,于术后15d移除缝线。组1中患者的不适症状和显微镜下所见显著性优于组2。组1中有1例患者术后胬肉复发,组2中有2例复发。组1与组2比较,平均手术费用较高但手术时间明显缩短,且差异具有统计学意义(P<0.05)。结论:翼状胬肉切除后,运用纤维蛋白胶固定植片能显著地减少患者术后的疼痛,并有效地缩短手术时间。     

纤维蛋白胶联合绷带型角膜接触镜在复发性翼状胬肉手术中应用

目的探讨纤维蛋白胶联合绷带型角膜接触镜应用于复发性翼状胬肉手术的临床效果。方法对2013～2015年期间我院复发性翼状胬肉60例（63只眼）行翼状胬肉切除联合带自体角膜缘干细胞的结膜移植术,随机分为试验组（ A）应用纤维蛋白胶联合绷带型角膜接触镜、对照组（ B）应用缝线法联合绷带型角膜接触镜,观察手术时间、术后眼部症状、愈合、复发率、不良反应,评价其临床疗效。结果2组间比较手术时间、术后眼部症状、愈合、复发率及不良反应A组均优于B组。结论对于复发性翼状胬肉,应用纤维蛋白胶联合绷带型角膜接触镜手术时间、术后症状、愈合、复发率、不良反应更优,具有广泛的临床实用价值。     

改良翼状胬肉切除自体角膜缘上皮球结膜移植

目的探讨改良翼状胬肉切除联合自体带角膜缘上皮的球结膜移植术的手术方法及临床效果。方法对77例（92眼）翼状胬肉行改良翼状胬肉切除联合自体带角膜缘上皮的球结膜移植术,随仿6～12个月,观察手术效果。结果87眼（94．57％）临床治愈、复发5眼,复发率：5．43％。结论改良翼状胬肉切除联合自体带角膜缘上皮的球结膜移植术是治疗翼状胬肉的较好手术方法,术中规范细致操作是保证术后低复发率的关键措施之一。     

表面麻醉下翼状胬肉手术中应用纤维蛋白胶的效果

目的：探讨奥布卡因表面麻醉及利多卡因局部麻醉下应用纤维蛋白胶在胬肉切除联合自体角膜缘干细胞移植术中的效果。

方法：对55例60眼行胬肉切除联合自体角膜缘干细胞移植手术治疗的初发性翼状胬肉患者,随机分为试验组(表面麻醉组)27例30眼和对照组(局部麻醉组)28例30眼。试验组给予常规奥布卡因表面麻醉后进行胬肉切除联合自体角膜缘干细胞移植术; 对照组给予20g/L利多卡因局部麻醉试验后进行胬肉切除联合自体角膜缘干细胞移植术。试验组及对照组均采用黏合剂将植片与植床进行粘贴(黏合剂为凝血酶溶液及含有因子Ⅷ和抑肽酶的纤维蛋白溶液)。术后随访6mo,主要观察手术时间,植床与植片的匹配程度及术中与术后患者的疼痛评分。

结果：试验组手术时间相对较短,差异有统计学意义(P=0.008),试验组植床与植片匹配度(93%)优于对照组(83%),具有统计学差异(P<0.05)。

结论：奥布卡因表面麻醉下使用纤维蛋白胶黏合剂完全能满足胬肉切除联合自体角膜缘干细胞移植术的要求,且能使植床与植片更好匹配,缩短了手术时间。     

翼状胬肉切除联合自体球结膜瓣移植术的临床分析

目的：探讨显微镜下施行翼状胬肉切除联合下方游离自体球结膜瓣移植术的疗效。方法：对93例97眼翼状胬肉施行翼状胬肉切除联合下方游离自体球结膜瓣移植术,观察术后恢复情况。结果：术后随访6～18mo,3眼复发（3%）,1眼并发炎性息肉（1%）,无其他并发症。结论：显微镜下翼状胬肉切除联合下方游离自体球结膜瓣移植术是治疗翼状胬肉的有效方法,具有术后复发率低且不影响白内障、青光眼手术切口选择的优点。     

A Comparative Study of the Effect of Fibrin Glue versus Sutures on Clinical Outcome in Patients Undergoing Pterygium Excision and Conjunctival Autografts

Purpose

To compare the effect of using fibrin glue or 10-0 nylon sutures on the clinical outcome of patients undergoing pterygium excision and conjunctival autografting.

Methods

We retrospectively reviewed the medical records of 52 eyes from 46 patients who underwent pterygium excision and conjunctival autografting and were followed up for more than 3 months. The operation duration, postoperative inflammation, complications, and recurrence rates were compared between groups of 20 patients (22 eyes) for whom fibrin glue was used (fibrin glue group) and 26 patients (30 eyes) for whom suturing was performed with 10-0 nylon (suture group) in pterygium excision and conjunctival autografting.

Results

The operation duration was 27.71 (5.22) minutes in the fibrin glue group and 43.30 (8.18) minutes in the suture group (p = 0.000). Seven days after the operation, the fibrin glue group showed milder conjunctival inflammation than the suture group (p = 0.000). Postoperative complications and corneal recurrence rates were not statistically different between the two groups.

Conclusions

The use of fibrin glue in pterygium excision with conjunctival autografting is likely to be a more effective, safer procedure than suturing.     

纤维蛋白胶与无缝无胶自体球结膜瓣固定术治疗翼状胬肉的疗效比较

目的：比较两种大小纤维蛋白胶与无缝无胶自体球结膜瓣固定术在原发性翼状胬肉手术中的患者舒适度、移植物稳定性、移植物炎症、复发等术后并发症。

方法：本研究对2014-12/2016-08共80例翼状胬肉患者(80眼)进行前瞻性介入对比研究。研究组随机抽取并分为两组,组1接受纤维蛋白胶疗法,组2采用无缝合无胶结膜自体移植固定术。每组再将等量的受试者随机平均分为两组(组1：组A+组B,组2：组C+组D)。组A(自体移植物的大小与裸眼巩膜相同)和组B(比裸巩膜大1 mm)实施纤维蛋白胶疗法; 组C(自体移植物的大小与裸眼巩膜相同)和组D(比裸巩膜大1 mm)采用无缝线无胶结膜自体移植固定术。每一位患者都接受翼状胬肉切除术,并根据组别使用不同大小的自体球结膜瓣。

结果：组1平均年龄为43.525,组2平均年龄为42.2。男性20例,女性60例。37例患者右眼有翼状胬肉。四组间平均手术时长相似。在术后随访期间,除结膜下出血(纤维蛋白胶组在术后1wk内明显增多)外, 4组间患者的舒适度、移植物回缩、移植物炎症和移植物水肿等术后参数均相似(P<0.0001)。组2仅3例患者出现4级移植物回缩/移位。术后1wk,组A和组D各出现1例移植囊肿患者。随访6mo后,组D中2例患者复发。

结论：两种方法均安全有效,术后不适及并发症少。与纤维蛋白胶疗法相比,无缝无胶疗法更加经济且效果相当。由于该手术成本低,且具有纤维蛋白胶疗法的所有优点,无缝无胶法可被认为是治疗患者非常有效的方法。     

Sandwich fibrin glue technique for attachment of conjunctival autograft during pterygium surgery

Objective

To report the results of a sandwich application of fibrin glue compared with the standard method of using fibrin glue for the attachment of the conjunctival autograft in pterygium surgery.

Participants

The study group consisted of 56 consecutive eyes with primary pterygium.

Methods

We performed a retrospective analysis comparing the standard method of using fibrin glue for the attachment of the conjunctival autograft during pterygium excision surgery versus the “sandwich technique.” In the “sandwich technique,” the thrombin component of the fibrin glue was applied after the graft was secured in position over a bed of fibrinogen.

Results

Graft dehiscence occurred in 3 eyes in the conventional group only. Recurrence occurred in 2 eyes in the conventional group and 1 eye in the sandwich group. None of the values reached statistical significance.

Conclusions

The sandwich technique simplifies conjunctival graft fixation during pterygium surgery with conjunctival autograft by allowing more time to properly position the autograft before fibrin clot formation.     

Comparison of fibrin glue with sutures for pterygium excision surgery with conjunctival autografts

Purpose:  To compare pterygium excision conjunctival autograft surgery using Tisseel fibrin glue versus Vicryl sutures.
Method:  Prospective randomized clinical trial. Fifty patients were randomized into either sutured graft or glued graft groups. Twenty-five received standard conjunctival autograft sutured with Vicryl and 25 received surgery with the autograft placed with Tisseel fibrin glue. Outcome measures include surgical time, patient discomfort, pathology, complications and recurrence rates at 3, 6 and 12 months. Patients were followed up at days 1, 7, 14, 30, 90, 180 and 365.
Results:  The mean surgical time for the glue group was significantly shorter at 12 min compared with the suture group at 26 min ( P  < 0.001). Postoperative pain was significantly less at day 1 ( P  < 0.001) and day 2 ( P  < 0.05) but was not significantly different following these visits. Complications in the glue group included one patient with an absent graft at week 1 that required revision of the graft. At 3 months there were no recurrences in the glue group and two recurrences in the suture group. The 6- and 12-month recurrence rate was unchanged and not significantly different between the glue and suture groups (both 0/24 and 2/23, respectively).
Conclusion:  Both glued and sutured conjunctival autografting procedures are safe and effective methods for pterygium surgery. The glued autograft recurrence rate at 12 months was similar to that of sutured grafts. Conjunctival autograft with fibrin glue in pterygium surgery decreased surgical time and resulted in less postoperative pain in the first 48 hours but had a higher complication rate.     

Rezidivraten nach Pterygiumoperation mit Bindehautschwenklappen vs. freies autologes Transplantat

BACKGROUND: After simple excision without additional surgical measures, pterygiums demonstrate high recurrence rates. According to the literature, recurrences may occur in up to 83% after simple excision compared to 5-21% after excision combined with conjunctival autografts. An alternative to the free conjunctival graft is the sliding conjunctival graft. METHODS: The data of 50 patients operated over a period of 8 years were evaluated retrospectively. The long-term results after pterygium excision with free conjunctival graft vs sliding conjunctival flap were compared with data extracted from the literature. RESULTS: The average follow-up was 23 months. During this period, 18.5% of 27 operated eyes with free conjunctival grafts developed a recurrence of pterygium. After excision with sliding conjunctival grafts only 6.9% of 29 operated and examined eyes developed recurrences. CONCLUSION: In the present study pterygium excision combined with sliding conjunctival graft was a simplified surgical technique with a lower recurrence rate compared to the free conjunctival graft.     

The cut-and-paste method for primary pterygium surgery: long-term follow-up

OBJECTIVE: To evaluate the recurrence rate, reoperation rate and side-effects of a novel technique for pterygium surgery. DESIGN: Retrospective study. PARTICIPANTS: The study included 461 eyes of 381 patients operated for primary nasal pterygium by the same surgeon between 1994 and 2003 and followed for 23 +/- 20 months (range 6-112 months). METHODS: Autologous conjunctival grafts harvested at the superotemporal limbus were used to cover the sclera after pterygium excision. Using a retrospective chart review, the outcome after attaching the transplant to the sclera with a fibrin tissue adhesive (n = 325) was compared to the outcome after graft attachment using absorbable sutures (n = 136). MAIN OUTCOME MEASURES: Recurrence rate, reoperation rate and complications. Results: The recurrence rate was 5.3% in the glue group and 13.5% in the suture group (p = 0.01). The reoperation rates were 1.2% and 3.3%, respectively (p = 0.31). Complications, such as transient transplant oedema and persistent corneal epithelial defects, occurred equally in both groups. CONCLUSION: Using a fibrin tissue adhesive instead of sutures when attaching the conjunctival transplant in primary pterygium surgery results in a significantly lower recurrence rate.