羊膜移植联合结膜瓣移植治疗复发性翼状胬肉的疗效观察

摘要

目的：探讨不使用丝裂霉素C（MMC）的羊膜移植联合带蒂结膜瓣移植术治疗复发性翼状胬肉的临床疗效。方法选取2010年1月至2013年6月于我院行羊膜移植联合带蒂结膜瓣移植术并经半年以上随访的复发翼状胬肉患者42例42眼，年龄26～74岁，观察期6～24个月。根据病例记载，对翼状胬肉有无复发、手术前后有无眼球运动障碍和睑球粘连、手术至复发的时间、术前既往手术次数等内容进行回顾性分析。结果42眼经长期随访观察，3级大胬肉的30眼中29眼（97％）未确认复发或复发后形成较小的胬肉，复发程度得到控制。同时，术前伴有睑球粘连和眼球运动障碍的病例术后分别有47％（17眼中8眼）和56％（25眼中14眼）得到改善。复发多见于术后6个月内，术后1年以上复发的仅有1例。在复发的8眼中有3眼（38％）需要再次手术。结论本术式未联合应用MMC ，在过去反复多次手术病例的81％中有效防止了复发。即使在复发的病例中胬肉的大小也得到了很好的控制。但仍有需要再次手术的病例，本术式也有一定的局限。存在重度睑球粘连和眼球运动障碍的病例有必要考虑联合MMC的术式。另外，应在根据客观检查判断睑球粘连和眼球运动障碍程度的基础上，结合复视这一主观检查作为术式选择时的指标。%Objective To investigate the clinical effect of amniotic membrane transplantation with autolo-gous conjunctival-flap transplantation without the use of mitomycin C for cases of recurrent pterygium .Methods Forty-two eyes of 42 patients (aged 26-74 years) with recurrent pterygium in our hospital from January 2010 to June 2013 underwent amniotic membrane transplantation with autologous conjunctival-flap transplantation were se-lected .Patients who did not undergo postoperative follow-up examination for at least 6 months were excluded . The follow-up time was 6-24 months .The recurrence of pterygium ,postoperative improvement of eye movement restriction and symblepharon ,the time interval between surgery and recurrence ,the number of prior surgeries were evaluated retrospectively from their medical records .Results Twenty nine of 30 eyes (97% ) with recurrent grade 3 pterygium didn′t recur or showed a reduction in the size of the new growth after surgery .The symblepha-ron improved postoperatively in 8 of 15 eyes (47% ) and restriction of eye movement improved in 14 of 25 eyes (56% ) .Most recurrences occurred within 6 months after surgery ,although 1 case did not show a recurrence until one year postoperatively .Conclusion Amniotic membrane transplantation with autologous conjunctival-flap trans-plantation without the use of mitomycin C reduced the size of the recurrent pterygium .However ,3 of the 8 eyes (38% ) required subsequent surgery , suggesting that the procedure has limitations . Therefore , mitomycin C should possibly be considered for patients with severe symblepharon or eye movement restriction .Diplopia can be an important indicator of the selection of surgical procedure.