不同手术方式治疗翼状胬肉的临床疗效分析

目的：探讨不同手术方式治疗翼状胬肉的临床效果。

方法：对我院2006-01/2010-12行不同手术方式治疗的164例206眼翼状胬肉患者的临床资料进行回顾性分析。A组(36例50眼)采用单纯切除术; B组(41例47眼)采用单纯切除联合丝裂霉素术; C组(42例52眼)采用胬肉切除联合丝裂霉素和羊膜移植术; D组(45例57眼)采用胬肉切除联合自体角膜缘干细胞移植术。记录每例手术时间,术后1wk; 3,6,12,24mo进行随访观察,观察结膜愈合及胬肉复发情况等。

结果：A组复发率最高,B组复发率有所降低,C、D 组复发率较A组及B组明显降低,C、D 组复发率无明显差异。手术时间方面,单纯切除组的手术时间明显短于其他组,羊膜移植及自体角膜缘干细胞移植组的手术时间较长。复发主要发生在术后1a内。

结论：丝裂霉素可以降低单纯胬肉切除术的复发率,角膜缘干细胞移植及羊膜移植术可以更有效的降低胬肉的复发率。     

翼状胬肉切除联合羊膜移植术的临床观察

目的观察在翼状胬肉切除术中应用人羊膜移植防止翼状胬肉复发的临床效果。方法对42例46只眼翼状胬肉(复发性翼状胬肉20例21眼,初发性胬肉22例25眼)进行手术切除联合羊膜移植术。结果随访时间3-36个月,平均19个月,40例44只眼术后上皮愈合稳定,角膜光滑透明,绝大部分患者术后视力较前提高,共2例复发,复发率4.5%。结论翼状胬肉切除联合羊膜移植术可有效降低翼状胬肉切除术的复发率。     

三种不同术式翼状胬肉切除术的临床对比观察

目的观察丝裂霉素C（MMC）或羊膜移植在翼状胬肉切除术中应用的临床疗效。方法对临床收治的需行翼状胬肉切除术病例随机分为3组进行手术。A组为单纯翼状胬肉切除;B组为翼状胬肉切除联合应用MMC,术中于翼状胬肉切除区巩膜面及结膜下放置0.4 mg/ml MMC 3 min;C组为翼状胬肉切除联合生物羊膜移植,于翼状胬肉切除区巩膜面植入瑞济干燥羊膜植片。术后1周、2周、1个月、3个月、1年、2年检查记录术眼并发症及复发情况。结果随访观察6个月至3年,A组60例（68只眼中）22只眼复发（32.4%）;B组60例（72只眼）中12只眼复发（16.7%）;C组50例（60只眼）中5只眼复发（8.3%）。A组与B组比较、A组与C组比较（P〈0.05）,差异具有显著性;B组与C组比较（P〉0.05）,复发率无显著性差异。结论翼状胬肉切除联合丝裂霉素C或生物羊膜移植手术、手术安全、可以减少翼状胬肉切除术后复发率。     

翼状胬肉的不同术式对创面上皮修复及复发率的影响

目的:比较羊膜移植、羊膜移植+丝裂霉素C处理和自体带结膜瓣的角膜缘干细胞移植等三种常见辅助治疗,对胬肉切除术术后角膜创面愈合和1a复发率的影响。方法:本研究为随机、单盲的前瞻性研究。选择160例190眼进展期翼状胬肉成年患者,在行胬肉切除手术时,随机辅助三种常见治疗:A组,羊膜移植(60例68眼);B组,羊膜移植+丝裂霉素C应用(50例62眼);C组,自体带结膜瓣的角膜缘干细胞移植(50例60眼)。随访、记录术后角膜创面愈合情况和1a复发率。结果:A,B和C三组患者角膜创面愈合时间分别为2.1±1.5,2.3±1.2和2.8±1.7d,以C组较长(P<0.05);A组术后2wk内有5例(7%)出现鼻侧结膜手术创缘肉芽肿生长,剪除后无再生,而B,C组未见创缘肉芽肿生长;术后1aA组11眼(16%)复发,与B组7眼(11%)和C组4眼(7%)相比较,具有统计学差异(P<0.05)。结论:羊膜移植+丝裂霉素C处理在促进术后角膜创面愈合和降低1a复发率疗效方面更有优势。     

羊膜移植和自体角膜缘干细胞移植治疗翼状胬肉

目的:探讨羊膜移植与自体角膜缘干细胞移植治疗翼状胬肉的疗效。方法:选取82例85眼翼状胬肉患者随机分为两组,A组:40眼,行翼状胬肉切除联合羊膜移植,B组:45眼,行翼状胬肉切除联合自体角膜缘干细胞移植。结果:随访9～32mo,A组术后复发2例,复发率5%;B组无复发,治愈率为100%,两组复发率无统计学意义。结论:两种方法治疗翼状胬肉均取得良好效果,翼状胬肉切除联合自体角膜缘干细胞移植疗效更加理想。     

The results of amniotic membrane transplantation for primary pterygium compared with conjunctival autograft

PURPOSE: To study the efficacy and safety of amniotic membrane transplantation as an adjunctive therapy after surgical excision of primary pterygium and to compare the clinical outcome with that of conjunctival autograft. METHODS: Eighty-six eyes of 78 patients with primary pterygium were operated on by a single surgeon (N.T.). All patients were randomized to undergo amniotic membrane or conjunctival autograft transplantation as an adjuvant therapy after pterygium excision. Forty-four eyes in 39 patients were treated with amniotic membrane transplantation (AM group), and 42 eyes of 41 patients were treated with conjunctival autograft (CG group). Patients were followed up at 1 week, 1, 3, 6, and 12 months postoperation. The main outcome measurement was a recurrence rate after surgery. RESULTS: The mean follow-up was 14.40 +/- 5.4 months in the AM group and 12.35 +/- 3.13 months in the CG group. There were 18 recurrences (40.9%) in the AM group and two (4.76%) in the CG group, which was significantly different among both groups (P < 0.007). The cumulative proportion that were recurrence-free at 12 months was 0.6 +/- 0.15 for the AM group and 0.95 +/- 0.07 for the CG group (P = 0.0003, Log-rank test). The cumulative nonrecurrence rate at 6 and 12 months in all patients stratified by age and sex was not significantly different (P = 0.28 and P = 0.9, Log-rank test). No major complications were observed in either group. CONCLUSION: The surgical results of primary pterygium excision followed by amniotic membrane and conjunctival autograft transplantation were compared. It was found that amniotic membrane transplantation for pterygium surgery has an unacceptably high recurrence rate.     

羊膜移植与结膜移植治疗翼状胬肉的比较

目的:比较翼状胬肉切除联合羊膜移植或游离自体结膜移植对原发性胬肉的治疗效果。方法:对65例74眼行翼状胬肉切除联合羊膜移植术,对61例69眼行翼状胬肉切除联合游离自体结膜移植术,观察两组病例术后疗效。结果:术后随访12～20mo,随访期内,羊膜移植组5例复发,复发率6.7%,结膜移植组8例复发,复发率11.6%。结论:两种方式均能显著降低胬肉术后复发率,但羊膜移植更为理想。     

羊膜移植在翼状胬肉术中的应用

目的观察保存人胎盘羊膜移植在翼状胬肉切除术后结膜重建及防止翼状胬肉复发中的疗效。方法对117例（143眼）翼状胬肉行广泛切除后，用保存人羊膜移植修补。结果术后2～3天角膜上皮修复，2～3周结膜血管化完成，与正常结膜不易区分。随访观察2～24月，治愈率91％。结论翼状胬肉切除联合羊膜移植术可有效地降低复发率。     

角膜缘上皮移植与羊膜移植治疗原发性翼状胬肉的对比观察

目的：对比观察翼状胬肉切除联合角膜缘上皮移植术与羊膜移植术对原发性翼状胬肉复发率的影响。
　　方法：采用随机对照分组的方法将我院手术治疗的原发性翼状胬肉患者99例103眼随机分为A,B两组。 A组为角膜缘上皮移植术组( n=54眼),采用翼状胬肉切除联合角膜缘上皮移植术;B组为羊膜移植术组( n=49眼),采用翼状胬肉切除联合羊膜移植术。术后随访1a,以泪膜破裂时间( breaking-up time,BUT)、复发率等指标作为分析参考指标。
　　结果：术后1a,联合角膜缘上皮移植术组有4眼(7.4%)复发。联合羊膜移植术组有11眼(22.5%)复发。两组复发率比较,差异有统计学意义( P<0.05)。两组间BUT比较无统计学意义(P>0.05)。
　　结论：相比羊膜移植术,翼状胬肉切除联合角膜缘上皮移植术治疗原发性翼状胬肉,能更有效的降低术后复发率。     

Randomised controlled study of conjunctival autograft versus amniotic membrane graft in pterygium excision

AIM: To determine whether amniotic membrane can be used as an alternative to conjunctival autograft after pterygium excision. METHODS: 287 eyes with either primary or recurrent pterygium were included in this study. All eyes were randomised to undergo conjunctival autograft or amniotic membrane transplantation after pterygium excision by a single surgeon. 106 eyes in primary pterygium and 14 eyes in the recurrent group were treated with conjunctival autograft, and 148 eyes in primary pterygium and 19 eyes in the recurrent group were treated with amniotic membrane transplantation. Patients were followed up at 6 weeks and 6 months after operation. The main outcome measurement was recurrence rate after surgery. RESULTS: In the conjunctival group, the recurrence rate was 12.3%, 21.4% and 13.1% for primary, recurrent and all pterygia, respectively. In the amniotic membrane group, the recurrence rate was 25.0%, 52.6% and 28.1% for primary, recurrent and all pterygia, respectively. The recurrence rate for all pterygia in the amniotic membrane group was significantly higher than that in the conjunctival group (p = 0.003). CONCLUSIONS: Amniotic membrane graft had a higher recurrence rate than conjunctival autograft. However, it is an alternative choice, especially for advanced cases with bilateral heads or patients who might need glaucoma surgery later.     

复发性与原发性翼状胬肉广泛切除联合羊膜移植治疗观察

目的:评估广泛性翼状胬肉切除联合羊膜移植术治疗复发性与原发性翼状胬肉的疗效。方法:回顾性分析作者手术治疗的复发性翼状胬肉患者38例40眼(A组)及原发性翼状胬肉195例231眼(分为B组156例185眼和C组39例46眼),追踪观察1～6a。结果:行广泛性翼状胬肉切除联合羊膜移植术后A组复发6眼,复发率为15%,B组复发11眼,复发率为6%。C组行单纯广泛性翼状胬肉切除术后复发10眼,复发率22%。A组与B组(P<0.05),B组与C组(P<0.01)间复发率的差异具有统计学意义。结论:广泛性翼状胬肉切除联合羊膜移植术治疗复发性与原发性胬肉安全有效,能降低术后复发率,但对原发性胬肉的效果更好。     

综合治疗复发性翼状胬肉疗效观察

目的:探讨综合治疗复发性翼状胬肉的疗效。方法:患者80例105眼均施行翼状胬肉切除联合平阳霉素注射及羊膜移植,术中用丝裂霉素,术后贝复舒眼液点眼的综合治疗。结果:随访6～18mo,胬肉复发2眼,复发率1.9%;术后并发眼部干、红、异物感等不适症状4眼,无1例发生角膜、巩膜溶解。结论:综合治疗能明显降低复发性翼状胬肉的术后再复发率。     

胚胎角膜干细胞移植治疗翼状胬肉的远期临床观察

目的　探讨体外培养的异体人胚胎角膜干细胞移植治疗原发性翼状胬肉的远期临床疗效。方法　原发性进行期翼状胬肉 3 2例 (3 2眼 ) ,随机分为两组 ,每组 16例 (16眼 )。实验组行翼状胬肉切除 以羊膜为载体的体外培养的异体人胚胎角膜干细胞移植术 ;对照组行翼状胬肉切除巩膜暴露术。术后随访 3年。手术由同一人操作。结果　实验组较对照组角膜上皮愈合快。实验组 1眼术后 3月内翼状胬肉复发 (复发率 6.2 5 %)。对照组 7眼术后不等时间翼状胬肉复发 (复发率43 .75 %)。实验组复发率低于对照组 (Fisher精确概率检验法检验结果P =0 .0 186<0 .0 5 )。实验组所有病例均未见其它并发症的发生。结论　应用以保存羊膜为载体的体外培养的异体人胚胎角膜干细胞移植治疗原发性翼状胬肉安全、有效。     

Amniotic membrane graft for primary pterygium: comparison with conjunctival autograft and topical mitomycin C treatment

AIM: To study the efficacy and safety of amniotic membrane graft as an adjunctive therapy after removal of primary pterygium, and to compare the clinical outcome with conjunctival autograft and topical mitomycin C. METHODS: 80 eyes of 71 patients with primary pterygia were treated with excision followed by amniotic membrane graft. The result was compared retrospectively with 56 eyes of 50 patients receiving conjunctival autograft, and 54 eyes of 46 patients receiving topical mitomycin C. Patients were followed for at least 6 months, and the averaged follow up periods for the three groups were 13.8, 22.8, and 18.4 months, respectively. RESULTS: There were three recurrences (3.8%) in the amniotic membrane graft group, three recurrences (5.4%) in the conjunctival autograft group, and two recurrences (3.7%) in the topical mitomycin C group. There was no significant difference in recurrence rate among the three groups (p = 0.879). No major complications occurred in the amniotic membrane graft group or the conjunctival autograft group. One case of infectious scleritis due to scleral ischaemia occurred in the topical mitomycin C group. CONCLUSION: This study showed that amniotic membrane graft was as effective as conjunctival autograft and mitomycin C in preventing pterygium recurrence, and can be considered as a preferred grafting procedure for primary pterygium.     

羊膜移植与自体角膜缘干细胞移植治疗原发性翼状胬肉的临床疗效比较

目的羊膜移植与自体角膜缘干细胞移植治疗原发性翼状胬肉的临床疗效比较。方法将114例（131眼）随机分成A和B两组。A组53例（59眼）行翼状胬肉切除＋羊膜移植术,B组61例（72眼）行翼状胬肉切除＋自体角膜缘干细胞移植术,术后随访6-24个月,观察两组疗效并进行回顾性分析。结果 A组10眼复发,复发率为16.95%,B组6眼复发,复发率为8.33%,两组比较差异具有统计学意义（P〈0.05）,A组复发率明显高于B组。结论翼状胬肉切除＋自体角膜缘干细胞移植术,此手术取材方便、成功率高;而翼状胬肉切除＋羊膜移植术,手术耗材、成功率明显较自体角膜缘干细胞移植术低。     

Outcome of surgery for recurrent pterygium using intraoperative application of mitomycin C and amniotic membrane transplantation

PURPOSE: Preserved human amniotic membrane has been used in reconstruction of the ocular surface. In this paper, we report our method of amniotic membrane transplantation (AMT) for recurrent pterygium. METHODS: Twenty-six eyes of 26 patients with recurrent pterygium are reported. All subjects were operated on with an extensive excision of the subconjunctival fibrous tissues followed by application of mitomycin C (0.04%, 3-5 min) during the operation. Amniotic membrane transplantation was performed with implantation of conjunctival autograft in cases with a large excision. RESULTS: The mean follow up time was 17.3 +/- 9.3 (mean +/- standard deviation) months. Twelve eyes showed severe symblepharon and 14 patients suffered from double vision before the operation. There were only three mild recurrences (12%), 11 patients recovered from double vision, and no major complications such as sclermalasia were noted during the follow-up period. CONCLUSION: AMT with application of mitomycin C is effective in preventing pterygium recurrence and for improved ocular movement. The cosmetic outcome of our methods has also been satisfactory.     

保存人羊膜和自体角膜缘移植术治疗复发性翼状胬肉临床观察

目的观察保存人羊膜和自体角膜缘移植治疗复发性翼状胬肉的手术效果。方法选择甘油保存的人羊膜,采用人羊膜和自体角膜缘移植术治疗复发性翼状胬肉76例(87只眼),术后随访1～3年．观察手术效果及复发率。结果治愈84只眼,复发3只眼,复发率3．4％,其中37只眼(42．5％)视力较术前提高。结论保存人羊膜和自体角膜缘移植术对阻止翼状胬肉的复发有较好疗效。     

新鲜羊膜移植治疗眼化学伤和翼状胬肉

目的：评价新鲜羊膜移植治疗眼化学伤和翼状胬肉的效果。方法：对16例(18只眼)眼化学伤患者进行新鲜羊膜移植，以及对36例(42只眼)翼状胬肉患者作翼状胬肉切除联合新鲜羊膜移植。结果：术后随访平均18个月，所有化学伤患者结膜、角膜均良好愈合，新生血管明显减少，视力超过0．3者占50．0％。翼状胬肉患者除2只眼外全部一次治愈，翼状胬肉复发率为4．8％。结论：新鲜角膜移植治疗早期眼化学伤有良好效果。翼状胬肉切除联合新鲜羊膜移植是治疗重症翼状胬肉特别是复发性病例的首选方法。     

羊膜移植联合丝裂霉素治疗翼状胬肉的临床疗效分析

目的：探讨术中应用羊膜移植联合丝裂霉素C降低翼状胬肉术后复发的效果。方法：将原发性翼状胬肉40只眼切除胬肉后，术中运用羊膜移植联合0.2mg／ml丝裂霉素，观察其术后的复发率和并发症。结果：随访6-18个月，39只眼角膜光滑，37只眼结膜光整不充血，2只眼轻度充血，1只眼复发，复发率为3％。结论：术中应用羊膜移植联合丝裂霉素能够达到进一步降低胬肉复发的目的，同时也避免了严重并发症的发生。     

翼状胬肉上结膜反向移植联合羊膜移植治疗复发胬肉

目的：观察胬肉上结膜反向移植联合羊膜移植治疗复发性翼状胬肉的疗效。

方法：回顾性系列病例研究。回顾2009-01/2012-01本院确诊的复发性翼状胬肉26例26眼,均为经历一次手术,手术方法为翼状胬肉切除联合自体角膜缘干细胞移植术,复发1a以上病例。本次研究中,切除胬肉组织时,将其上结膜充分游离后切下保存,羊膜覆盖胬肉切除后裸露巩膜面,再将保留的胬肉上的结膜植片反向覆盖羊膜上缝合。术后1,2wk; 1mo及3mo观察结膜植片愈合情况、羊膜溶解吸收时间、角膜创面修复时间、角膜新生血管及胬肉复发率。术后随访12mo。

结果：结膜植片愈合时间6.03±2.76d,羊膜溶解吸收时间14.26±3.64d,角膜创面修复时间5.42±1.58d。术后3mo,胬肉切除后裸露巩膜面新生结膜及结膜植片愈合良好,无明显胬肉术后并发症。术后1a,再度复发2例,复发率8%,治愈率92%。

结论：对于复发性翼状胬肉,因传统自体角膜缘干细胞移植已经创伤部分角膜缘及眼表结膜瘢痕,单纯结膜移植,或单纯羊膜移植,术后胬肉复发率偏高,本方法取胬肉上结膜反向移植,避免大面积创伤眼表,取材容易,而且良好控制术后翼状胬肉复发问题,不失为一种解决复发性翼状胬肉的良好选择。