翼状胬肉两种手术方法的临床效果比较

目的 对比两种手术方法治疗翼状胬肉的临床效果.方法 翼状胬肉46例（51只眼）随机分成两组,每组均为23例.第1组,翼状胬肉切除加自体角膜缘干细胞移植 第2组,翼状胬肉切除加带蒂结膜瓣转移术中联合应用丝裂霉素C.观察术后角膜上皮修复、角膜缘新生血管及翼状胬肉复发情况.结果 术后随诊6～36月,第1组中有1只眼复发（4.35%）,第2组有2只眼复发（8.70%）.结论 翼状胬肉切除加自体角膜缘干细胞移植及翼状胬肉切除加带蒂结膜瓣转移术中联合应用丝裂霉素C均能有效阻止胬肉复发.但前者在手术安全性、舒适性、术后并发症等方面更具优势.     

复合式翼状胬肉切除术与单纯翼状胬肉切除术的疗效比较

目的比较复合式翼状胬肉切除术和单纯翼状胬肉切除术的临床疗效。方法将235例(261只眼)原发性翼状胬肉患者随机分为2组:带蒂结膜瓣移植联合MMC切除术组118例(125只眼),单纯翼状胬肉切除术组117例(136只眼)。复合式切除术组联合应用丝裂霉素C和带蒂结膜瓣移植,其他手术操作步骤与单纯翼状胬肉切除术组基本相同。结果复合式翼状胬肉切除术组6只眼复发,复发率4.8%;单纯翼状胬肉切除术组33只眼复发.复发率24.2%。2组术后复发率差异有统计学意义。结论胬肉切除、MMC联合带蒂结膜瓣移植复发率低,手术安全.疗效可靠。     

翼状胬肉逆行切除联合丝裂霉素C结膜瓣下“C”形浸润术的疗效观察

目的观察翼状胬肉逆行切除联合丝裂霉素C结膜瓣下＂C＂形浸润术治疗翼状胬肉的临床效果。方法对120例翼状胬肉行逆行切除联合丝裂霉素C结膜瓣下＂C＂形浸润术,术后随访6-12个月。结果 156只眼中148只眼治愈,8只眼复发,复发率5.13%。结论翼状胬肉逆行切除联合丝裂霉素C结膜瓣下＂C＂形浸润术操作简便,疗效佳,复发率低。     

带蒂结膜瓣转移联合丝裂霉素C治疗复发性翼状胬肉的临床研究

目的:探讨带蒂结膜瓣转移联合应用丝裂霉素C治疗复发性翼状胬肉的临床疗效。方法:对26例(26眼)复发性翼状胬肉患者,采用翼状胬肉切除、术中加用丝裂霉素C并行带蒂结膜瓣转移、术后低浓度丝裂霉素C点眼进行治疗并随访观察。结果:所有患者均接受了6~12mo随访,有1例患者复发,复发率为4%。没有并发症发生。结论:对复发性翼状胬肉,翼状胬肉切除术中加用带蒂结膜瓣转移联合应用丝裂霉素C,是一种有效的治疗方法。     

带蒂结膜瓣移植联合MMC治疗翼状胬肉合并结膜松弛症

目的：探讨带蒂结膜瓣移植联合丝裂霉素治疗翼状胬肉合并结膜松弛症的疗效。 方法：对翼状胬肉合并结膜松弛症患者122例156眼进行翼状胬肉切除,下方带蒂结膜瓣移植联合术中使用0.2g/L丝裂霉素C。 结果：患者122例156眼术后2mo眼部症状有不同程度改善。泪河恢复正常者136眼（87.18％）;泪膜破裂时间（BUT）≥10s者117眼（75.00％）;裂隙灯显微镜检查眼球与下睑缘、内外眦部之间无松弛结膜皱褶者147眼（94.23%）;下睑缘位置正常者142眼（91.03%）。手术后观察6mo~4a,胬肉复发5眼（3.21%）,结膜松弛复发15眼（9.62%）。 结论：翼状胬肉切除术中,下方带蒂结膜瓣移植联合术中使用丝裂霉素C治疗翼状胬肉合并结膜松弛症,手术简单易行,取材容易,安全可靠,损伤小,并发症少,复发率低,适合临床开展。     

翼状胬肉不同术式效果观察

目的寻求一种理想的手术方法以减少胬肉术后的复发率。方法对636例726眼采用单纯胬肉切除术(209眼)。带蒂结膜瓣转移术(158眼)，保存羊膜移植术(94眼)，丝裂霉素C应用加带蒂结膜瓣转移术(131眼)，自体角膜缘干细胞移植术(134眼)等方法治疗，随访6月至7年，比较其复发率。结果术后复发率，单纯胬肉切除为29．67％，带蒂结膜瓣转移术为20．25％，保存羊膜移植术为15．96％，丝裂霉素C应用加带蒂结膜瓣转移术为6．11％，自体角膜缘干细胞移植术为3．73％。结论自体角膜缘干细胞移植术和丝裂霉素C应用加带蒂结膜瓣转移术减低了胬肉的复发率。取得了良好的效果，是二种理想的手术方法。值得推广。     

带蒂结膜瓣移植联合丝裂霉素治疗翼状胬肉的疗效分析

目的:观察带蒂结膜瓣移植联合丝裂霉素C治疗翼状胬肉的临床效果,探寻减少复发的最佳术式。方法:对131例131眼行翼状胬肉切除术、联合丝裂霉素C湿贴、带蒂结膜瓣移植术,术后点重组牛碱性成纤维细胞生长因子及氧氟沙星滴眼液。结果:患者术后随访观察6mo～2a,131例131眼有4眼复发,复发率为3.1%。结论:带蒂结膜瓣移植联合应用丝裂霉素C湿贴治疗翼状胬肉,复发率较低,手术简单易行,费用低,不失为一种好办法,尤其针对基层医院比较适合。     

不同术式治疗翼状胬肉的疗效观察

目的:寻求一种治疗翼状胬肉的理想手术方式。方法:对121眼采用单纯胬肉切除加巩膜暴露术(49眼)、带蒂结膜瓣转位术(43眼)及加丝裂霉素C的辅助疗法(29眼)3种显微手术方法治疗。随访2mo~4a,比较其复发率。结果:胬肉切除加丝裂霉素C辅助疗法术后无1例复发,单纯胬肉切除加巩膜暴露术复发率为12.3%,带蒂结膜转位术复发率为9.3%,3种手术方法均有部分病例周边角膜云翳。结论:胬肉切除加丝裂霉素C辅助治疗是一种相对理想的手术方法。     

结膜瓣转移联合低浓度丝裂霉素C治疗翼状胬肉

目的　评价自体带蒂结膜瓣移植联合低浓度丝裂霉素C(MMC)术中局部应用治疗原发性进行期翼状胬肉及复发性翼状胬肉的效果。方法　选择 72例 81眼 ,在手术显微镜下施行翼状胬肉切除、自体结膜瓣转位移植、并联合术中局部应用0 0 0 2 % ( 0 2mg/10mL)MMC ,随访 12～ 48月 ,观察胬肉的复发情况。结果　复发率为 6 17% ( 6/81) ,明显低于文献报道翼状胬肉单纯切除 2 5 %～ 45 %的复发率 ,差异有非常显著意义 (P <0 0 0 1)。结论　自体结膜瓣转位移植联合低浓度MMC术中局部应用治疗进行期翼状胬肉和复发性翼状胬肉 ,术后复发率明显低于翼状胬肉单纯切除术 ,疗效可靠 ,术后并发症少 ,创面愈合快。是治疗翼状胬肉一种较简单有效的方法     

不同术式治疗翼状胬肉的疗效分析

目的分析3种不同的手术方式治疗翼状胬肉的临床效果,探寻减少复发的最佳术式。方法第1组44例（46眼）行单纯翼状胬肉切除术;第2组44例（44眼）行带蒂结膜瓣移植联合丝裂霉素C湿贴术;第3组41例（41眼）行角膜缘干细胞移植术。结果术后随访观察6个月至2年。第1组有10眼复发、复发率为21.74%;第2组有2眼复发、复发率为4.54%;第3组有1眼复发、复发率为2.44%。结论带蒂结膜瓣移植联合应用丝裂霉素C湿贴治疗翼状胬肉,较单纯切除术的复发率低。自体角膜缘干细胞移植可有效降低翼状胬肉术后的复发率最低。     

两种术式治疗翼状胬肉的疗效观察

目的:分析两种不同的手术方式治疗翼状胬肉的临床效果。方法:第1组33例35眼,有2例2眼为复发病例,采用翼状胬肉切除联合游离球结膜瓣移植术。第2组32例35眼,有2例2眼为复发病例,采用翼状胬肉切除联合游离球结膜瓣移植加丝裂霉素棉片术。结果:术后1a内随访,第1组复发1例(1眼),复发率3.03%(2.85%)。第2组复发1例(1眼),复发率3.12%(2.85%),有1例发生球结膜瓣愈合不良,于术后20d拆除结膜瓣缝线。无巩膜溶解等严重并发症。结论:翼状胬肉切除联合游离球结膜瓣移植术与翼状胬肉切除联合游离球结膜瓣移植加丝裂霉素棉片术,复发率均较低,两组间没有差异。     

Long-term follow-up study of mitomycin eye drops as adjunctive treatment of pterygia and its comparison with conjunctival autograft transplantation

We observed 48 patients for 7-21 months (mean, 18 months) after pterygium excision and 2 weeks of placebo or mitomycin topical therapy to evaluate whether or not the short-term efficacy of mitomycin in preventing pterygium recurrence would be reflected in long-lasting efficacy as well. Placebo-treated pterygia showed a 73% recurrence rate. One of 58 (1.7%) mitomycin-treated pterygia recurred (p less than 0.05). We also performed a pilot study comparing pterygia treated with excision followed by 0.4 mg/ml of mitomycin to pterygia treated with excision coupled with conjunctival autograft transplantation to estimate the number of patients required for a randomized clinical trial comparing these two treatment modalities and thereby to decide whether or not such a study would be justified. Thirteen primary and two recurrent pterygia were treated with mitomycin, while 14 primary and one recurrent pterygia were treated with conjunctival autograft transplantation. With mean follow-up times of 4 and 6 months, respectively, no recurrences were noted in the mitomycin-treated group, while the conjunctival autograft transplantation group had one recurrence (6.6%). We estimate that 400 patients would be required for a properly designed clinical trial comparing these two effective therapies for prevention of recurrent pterygia. We conclude that such a study is unjustified, and further conclude that the vastly less expensive, simple therapy of mitomycin eye drops is the more appropriate treatment.     

复发性翼状胬肉33眼手术疗效观察

目的:观察复发性翼状胬肉不同手术方法的术后再复发率及并发症。方法:我院2006-11/2009-02对31例33眼复发性翼状胬肉患者(伴有睑球粘连,眼球运动不同程度受限者12眼)施行翼状胬肉切除、丝裂霉素创面贴敷、自体结膜(带蒂或游离)移植或羊膜移植手术,手术方式:彻底切除净胬肉组织,裸露巩膜创面以0.2g/L丝裂霉素C溶液浸湿的棉片贴敷3min后,用生理盐水冲洗干净。巩膜创面覆盖方法:上或(和)下方结膜转位移植26眼,颞上方结膜游离移植2眼,羊膜移植5眼。结果:随访9mo～3a,胬肉未复发28眼;轻度复发(鼻侧球结膜及结膜下组织充血增厚,但未长入角膜缘或长入角膜缘内≤2mm)5眼,复发率15%,其中结膜转位移植4眼,羊膜移植1眼;睑球粘连轻度复发3眼;术后并发结膜肉芽肿1眼,眼部干痛、有时红卡等不适症状5眼,无1例发生角膜、巩膜溶解。结论:翼状胬肉切除联合自体结膜移植或羊膜移植及丝裂霉素创面贴敷的手术方式能明显降低复发性翼状胬肉的术后再复发率。     

Role of mitomycin C in pterygium surgery.

Mitomycin C in the form of eye drops in a concentration of 0.4 mg/ml (0.04%) was used as adjunctive treatment for primary and recurrent pterygium after surgical excision. The study was concurrent in nature and consisted of 32 pterygia in 30 patients and was done over a period of 36 months. The object was to observe the effect of mitomycin C drops on pterygium recurrence after surgical excision. Fifteen eyes of 15 patients were treated with 'bare sclera technique' for pterygium excision. Nine patients showed recurrence occurring within first 6 months of surgery. On the other hand 17 eyes of 15 patients after bare sclera pterygium excision received mitomycin 0.4 mg/ml (0.04%) eye drops four times a day for 2 weeks from first postoperative day. There was no recurrence of pterygium in this group. Follow up time for these cases ranged from 13-19 months.     

翼状胬肉切除联合角膜缘干细胞移植及术后药物治疗临床观察

目的:观察翼状胬肉切除联合角膜缘干细胞移植及术后药物治疗翼状胬肉的临床疗效。方法:共行翼状胬肉切除联合角膜缘干细胞移植术治疗的翼状胬肉患者760例980眼。选取亚复发期的162例162眼进行观察,随机分为A,B两组,A组滴1g/L丝裂霉素C+诺氟沙星滴眼液1～3mo;B组交替滴地塞米松滴眼液、双氯芬酸钠滴眼液1～3mo。结果:A组痊愈67眼(81.7%),亚复发12眼(14.6%),复发3眼(3.7%)。B组痊愈35眼(43.8%),亚复发29眼(36.3%),复发16眼(20.0%)。A组复发率明显低于B组(P<0.01)。结论:翼状胬肉切除联合自体角膜缘干细胞移植术,无排斥反应、安全有效、术后复发率低,术后给予滴眼液后续治疗尤为重要,更能有效地抑制和降低翼状胬肉术后的复发率,能明显提高治疗效果。     

Combined mitomycin C application and free flap conjunctival autograft in pterygium surgery

PURPOSE: To evaluate the long-term postoperative outcome and complication rate of combined intraoperative low-dose mitomycin C application and free conjunctival autograft for the treatment of pterygium. METHODS: In a prospective, consecutive, noncomparative case series, a series of 46 consecutive patients (50 eyes) with primary pterygium (43 eyes) or recurrent pterygium (7 eyes) were studied. The patients' ages ranged from 23.0 to 80.0 years (mean, 53.4 years). All patients underwent pterygium excision combined with intraoperative low-dose mitomycin C application (0.02% for 2 minutes) and free conjunctival autograft. The mean follow-up period was 29.2 months (range 12 to 41 months). The main outcome measures were recurrence of pterygium and postoperative complications. RESULTS: Pterygium recurred to a small extent (0.5 mm) in one eye (2%) of a patient with recurrent pterygium. There were no intraoperative complications. Subconjunctival graft hematoma appeared soon after surgery and resolved spontaneously in five eyes (10%). One eye developed transient high intraocular pressure without optic nerve or visual field defect, and one eye developed mild symblepharon. There were no sight-threatening complications or serious side effects. CONCLUSIONS: By applying a single low dose of mitomycin C combined with free conjunctival autograft during pterygium excision, the recurrence rate of pterygium can be markedly reduced.     

改良性带蒂结膜瓣移植治疗翼状胬肉的疗效观察

目的:对改良性带蒂结膜瓣移植治疗翼状胬肉的有效性进行观察。方法:复发性翼状胬肉患者35例35眼,施行改良性带蒂结膜瓣移植手术治疗翼状胬肉,术后随访6mo～1a,观察疗效及复发情况。结果:35眼复发性翼状胬肉,2眼(6%)复发。讨论:改良性带蒂结膜瓣移植手术治疗翼状胬肉,手术方便,复发率低,疗效可靠。     

表皮生长因子在翼状胬肉术后的应用观察

目的 观察重组人表皮生长因子（rhEGF）在角膜缘干细胞移植治疗翼状胬肉术后的效果。方法 切除翼状胬肉后取术眼下方角膜缘上皮连同部分结膜上皮组织制成移植片，移植于角膜上皮缺损处，治疗原发性和复发性翼状胬肉68例（72眼），术后实验组给予rhEGF滴眼剖局部治疗。随访6～12月。结果 术后角膜创面上皮修复自近移植片的周边部向中央移行，对照组角膜上皮痊愈时间为7天，实验组角膜上皮痊愈时间5天，两者差异有统计学意义（P〈0.01）。结论 自体角膜缘干细胞移植术联合rhEGF局部滴眼能缩短角膜上皮缺损的愈合时间。