显微镜下角膜缘干细胞移植联合胬肉切除治疗翼状胬肉198例：不同种族患者的对比分析

背景：大多数针对翼状胬肉治疗效果的研究都着眼于手术技巧、辅助治疗手段和患者自身原因对胬肉切除后复发率的影响，种族因素与胬肉的发生发展及复发是否有关仍无确切依据。 目的：对不同种族的翼状胬肉患者施行自体角膜缘干细胞移植联合翼状胬肉切除，观察比较其治疗结果。 设计、时间及地点：回顾性病例分析，于2000-01/2006-06在厦门大学附属中山医院眼科完成。 对象：厦门大学附属中山医院眼科同期收治的中国汉族翼状胬肉患者144例（152眼），均为初发病例；作者在非洲同期接诊的黑色人种翼状胬肉患者54例（54眼），均为复发病例。两组患者在年龄、性别组成、胬肉长度等方面差异无显著性意义（P > 0.05）。 方法：198例患者显微镜直视下常规切除翼状胬肉，力求角膜面无胬肉组织残留。取患者自体颞上方球结膜的带角膜缘的薄层游离结膜瓣，覆盖于翼状胬肉切除创面区。术后6周及6，12个月进行随访，患眼分级标准为1~4级，级别越高复发程度越严重。 主要观察指标：胬肉切除联合角膜缘干细胞移植后的复发情况、患眼分级及并发症。 结果：第6周两组均未发现翼状胬肉复发，6个月时中国汉族与非洲黑色人种胬肉患者的复发率分别为6.6%和14.8%，12个月时分别为11.8%和24.5%，后者术后复发率明显高于前者（t=4.607，P=0.032）。第6周两组患眼分级情况存在显著差异 （χ2=15.608，P < 0.01），中国汉族胬肉患者恢复较快；至6，12个月时两组患眼分级无明显差异（χ2=4.401，6.206，P > 0.05）。两组患者并发症均较少，主要为角膜浅层瘢痕、持续性眼表刺激症状。 结论：显微镜下行自体角膜缘干细胞移植联合翼状胬肉切除的方法，具有切除胬肉较彻底、组织损伤小、复发率较低的优势，有一定的临床实用价值。非洲黑色人种翼状胬肉患者的术后复发率高于中国汉族翼状胬肉患者。

Treatment for pterygium using corneal limbal stem cell autograft combined with excision of pterygium under a microscope A contrast analysis in 198 patients of different races

BACKGROUND: Therapeutic effect on pterygium mainly focuses on studying surgical technique, assistant therapy methods, and recurrence rate following excision of pterygium; however, whether race factor is associated with occurrence, development, and recurrence of pterygium remains still unknown. OBJECTIVE: To compare the therapeutic outcomes in different race patients with pterygium treated using corneal limbal stem cell autograft combining with excision of pterygium. DESIGN, TIME AND SETTING: Retrospective case analysis, performed in the Department of Ophthalmology, Zhongshan Hospital Affiliated to Xiamen University between January 2000 and June 2006. PARTICIPANTS: 144 (152 eyes) primary cases were collected from Xiamen and 54 (54 eyes) relapsed Negroes were from Africa. There were no significant differences in age, sex, and pterygium length between the two groups (P > 0.05). METHODS: 198 subjects were treated by excision of pterygium under a microscope, in which pterygium tissue was not found on the surface of cornea. A free transplantation of the superotemporal limbus with an adjacent piece of thin conjunctiva was placed in the excision area. All cases were followed-up to grade the appearances of the sites 6 weeks, 6 and 12 months after excision (grade 1 implied normal appearance, and grade 4 implied the relapse). MAIN OUTCOME MEASURES: Relapse, pterygium grading, and complication after corneal limbal stem cell autograft combining with excision of pterygium. RESULTS: No relapse was found at 6 weeks after operation. The recurrence rate of Chinese Han people and Africa black people were 6.6% and 14.8% respectively at 6 months, and 11.8% and 24.5% at 12 months. There was significant difference in the recurrence rate between the two races (t=4.607, P = 0.032). In addition, there were significant differences in the pterygium grading between the two groups at 6 weeks (x2=15.608, P < 0.01), and Chinese people recovered better. Contrarily, there was no statistical difference at 6 months and 12 months (x 2=4.401, 6.206; P > 0.05). Few complications were found except superficial scar of cornea and persistent irritation of ocular surface. CONCLUSION: Limbal stem cell autograft combining with excision of pterygium under a microscope can completely remove pterygium with minimal invasion, light postoperative response and low rate of recurrence. The relapse of black cases is higher than Chinese patients.