3 ]" c5 _. Z0 Z, G4 Z: H. } 0 e, \3 g! ]" G. ~9 y
" V* Y, b' x1 N! s. T. L# [! b! m
+ c; t' {3 o. |6 i6 w W2 c 6 o+ m( P+ b I/ C5 n: R7 | . }0 }0 ]. K7 D" r
% M( e# n& ^/ h
+ L, @$ n+ k1 Z f8 K* d- { " K, T A ]* j' @& r$ A( f/ `- n ! u) h+ c1 I" T' W' n4 q2 O5 j' U" _ 【摘要】 目的 比较治疗翼状胬肉三种不同术式的疗效，探寻翼状胬肉治疗的最佳方法。方法 120例（138眼）翼状胬肉患者随机分为A、B、C组，A组67眼行翼状胬肉切除联合自体角膜缘干细胞移植；B组54眼联合异体羊膜移植；C组17眼行准分子激光治疗性角膜切削术（PTK）。术后随访观察3月至2年，比较各组患者术后翼状胬肉复发情况。结果 A组67眼中4眼复发，复发率6%；B组54眼复发9眼，复发率17%；C组17眼，未见复发。A组与B组比较（χ2=4>χ2 0.05=3.84，P) k0 I# @2 M$ [* Q( Q9 P. Y# n9 V
【关键词】翼状胬肉；角膜缘干细胞移植；羊膜移植；准分子激光治疗性角膜切削术5 v+ v8 k6 V" ?2 |' g; |, v8 i
Curative Effect Comparison of Three Operation Methods for Pterygium/ c7 }, R. t$ ^+ G1 m
9 K: D. D% N3 Q; \" x6 VGAO Yunxia, JIANG Xiuqin, LIU Fangyi, the People's Hospital of Linyi City, Shandong Province 27600037 a7 X, Q( g3 |' M J
6 w2 x, N1 P) J! R% o/ L3 h$ zＡＢＳＴＲＡＣＴＯｂｊｅｃｔｉｖｅTo compare the curative effect of 3 different operation methods for pterygium so as to find out the best one.Ｍｅｔｈｏｄｓ138 eyes of 120 patients with pterygium were randomly divided into 3 groups: Group A, B and C.67 eyes in Group A received pterygium incision with transplantation of corneal limbal stem cells; 54 eyes in Group B received pterygium incision with allotransplantation of amniotic membrane; 17 eyes in Group C received pterygium incision with photorefractive keratectomy (PTK). Follow-up after operation lasted from 3 months to 2 years, and the reoccurrence in each group was compared.Ｒｅｓｕｌｔｓ4 eyes out of 67 eyes in Group A had reoccurrence (6%), 9 eyes out of 54 eyes in Group B (17%) and no reoccurrence was found in the 17 eyes in Group C. The comparison between Group A and Group B (χ2=4>χ20.05=3.84,P % S( j5 a. \: s$ M0 I# z* ?; w" `; i* G% u* b+ h9 }* T
ＫＥＹＷＯＲＤＳpterygiumtransplantation of corneal limbal stem cellsTransplantation of amniotic membranePTK0 f" U8 Y6 N! w- w: P
# @0 X* B- f+ J9 j
翼状胬肉是一种眼科常见的多发病，在临沂地区尤为常见。当翼状胬肉进展到角膜瞳孔区或影响美观时，其最佳方法是手术切除。单纯胬肉切除术后复发率较高，且生长较快。临床上有多种手术方法与药物联合等治疗方式以期减少其复发率，达到治愈目的。目前认为翼状胬肉切除联合角膜缘干细胞移植或羊膜移植效果比较明显，能显著减低其复发率。我们自2002年起观察翼状胬肉切除联合自体角膜缘干细胞移植67眼，联合异体羊膜移植54眼，准分子激光治疗性角膜切削术治疗17眼，比较三种不同术式疗效。! g& r. Z% z* E/ m
1 `- V7 G7 R) L3 a) _
1资料与方法8 F2 N: a9 b! @
% \5 X2 x& g/ U E1.1一般资料本组病例共120例，138眼，其中初发性翼状胬肉100例117眼，复发性翼状胬肉20例21眼，男性51例63眼，女性69例75眼，年龄35-68岁，平均51.3岁，职业以农民居多。所有患者翼状胬肉头部进入透明角膜均大于2mm。随机分为A、B、C组，A组67眼行翼状胬肉切除联合角膜缘干细胞移植；B组54眼行翼状胬肉切除联合羊膜移植；C组17眼均为初发性翼状胬肉行翼状胬肉切除联合PTK。其中复发胬肉13眼行羊膜移植，8眼行角膜缘干细胞移植。 3 ^% H5 C$ l- Q; t* t( B7 g1 R8 A1 |, C4 \; ]; u& l9 F q
1.2异体羊膜采取商业成品制作保存的羊膜。术前根据胬肉大小取不同面积羊膜植片，移植前20分钟进行复温处理。: M% O. H& g+ ?6 z" {' ?- h5 c/ g