本文關鍵詞：結膜瓣遮蓋手術在難治性角膜疾病治療中的作用評價　出處：《第三軍醫(yī)大學》2016年碩士論文　論文類型：學位論文

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【摘要】：目的:評價結膜瓣遮蓋術在各種類型難治性角膜疾病治療中的療效。方法:采用回顧性分析的方法,對第三軍醫(yī)大學西南醫(yī)院眼科2001-2014年住院和采用結膜瓣遮蓋手術治療的各種類型難治性角膜疾病患者161例(161只眼)進行分析,161例患者均為經過針對性藥物治療無效或病情加重者。其中,感染性角膜潰瘍118例,非感染性角膜疾病43例。前者包括真菌性角膜潰瘍71例,細菌性角膜潰瘍16例,單純皰疹病毒性角膜潰瘍31例。后者包括大泡性角膜病變22例,神經麻痹性角膜潰瘍6例,角膜移植片潰瘍10例,角膜異物取出后穿孔或接近穿孔5例。所有患者均由同一術者行橋式結膜瓣遮蓋手術。術后依據(jù)原發(fā)病繼續(xù)使用藥物治療。隨訪3~106個月,觀察臨床療效。結果:161例患者中,共治愈141例,治愈率87.6%。其中,感染性角膜潰瘍(包括真菌性、細菌性、單純皰疹病毒性角膜潰瘍)118例中,共治愈99例,治愈率83.9%。真菌性角膜潰瘍治愈54例(54/71),治愈率76.1%;細菌性角膜潰瘍治愈15例(15/16),治愈率93.8%;單純皰疹病毒性角膜潰瘍治愈30例(30/31),治愈率96.8%。非感染性角膜疾病43例中,治愈42例,治愈率97.7%。大泡性角膜病變治愈21例(21/22),治愈率為95.5%;神經麻痹性角膜潰瘍治愈6例(6/6),治愈率為100%;角膜移植片潰瘍治愈10例(10/10),治愈率為100%;角膜異物取出后穿孔或接近穿孔治愈5例,(5/5)治愈率為100%。感染性角膜潰瘍的治愈率與非感染性角膜疾病的治愈率相比差異有統(tǒng)計學差異(P0.05),非感染性角膜疾病的治愈率明顯高于感染性角膜疾病。在感染性角膜疾病中,非急性化膿性角膜潰瘍(單純皰疹病毒性角膜潰瘍)的治療效果優(yōu)于急性化膿性角膜潰瘍(真菌、細菌)(P0.05)。共發(fā)生21例(21只眼)手術并發(fā)癥,其中結膜瓣部分溶解11例,結膜瓣穿孔4例,結膜瓣滑脫4例,繼發(fā)青光眼2例。感染性角膜疾病中,手術后發(fā)生并發(fā)癥20例,發(fā)生率16.9%,非感染性角膜疾病手術后并發(fā)癥1例,發(fā)生率2.3%,兩者并發(fā)癥發(fā)生率比較,差異有統(tǒng)計學意義(P0.05),非感染性角膜疾病手術并發(fā)癥的發(fā)生率明顯低于感染性角膜疾病。結論:結膜瓣遮蓋手術對各種類型的難治性角膜疾病治療效果顯著,對非感染性角膜病變的療效優(yōu)于感染性角膜病。對于急性化膿性角膜潰瘍,手術前進行針對性治療可能有助于提高手術的成功率。
[Abstract]:Objective: to evaluate the efficacy of conjunctival flap covering in the treatment of various types of refractory corneal diseases. A total of 161 patients with various types of refractory corneal diseases (161 eyes) admitted to the Southwest Hospital of the third military Medical University from 2001 to 2014 and treated with conjunctival flap covering surgery were analyzed. 161 cases were all ineffective or aggravated by targeted drug therapy, including 118 cases of infective corneal ulcer and 43 cases of non-infectious corneal disease. The former included 71 cases of fungal corneal ulcer. There were 16 bacterial corneal ulcers and 31 herpes simplex corneal ulcers, including 22 cases of vesicular keratopathy, 6 cases of nerve paralysis corneal ulcers and 10 cases of corneal allograft ulcers. There were 5 cases of corneal foreign body perforation or near perforation after removal. All the patients were covered by bridge conjunctival flap in the same operation. After operation, the patients were treated with drugs according to the primary disease. The follow-up period was 3 ~ 106 months. Results 141 cases were cured, and the cure rate was 87.6%. Among them, infectious corneal ulcer (including fungal and bacterial). In 118 cases of herpes simplex virus corneal ulcer, 99 cases were cured, the cure rate was 83.9%. 54 cases of fungal corneal ulcer were cured, the cure rate was 76. 1%. 15 cases of bacterial corneal ulcer were cured, and the cure rate was 93.8%. 30 cases of herpes simplex virus corneal ulcer were cured, the cure rate was 96. 8%. Of 43 cases of non infectious corneal diseases, 42 cases were cured. The cure rate was 97.70.21 cases of Bubular keratopathy were cured, and the cure rate was 95.5%. Nerve paralysis corneal ulcer was cured in 6 cases (6 / 6), and the cure rate was 100%. The corneal allograft ulcer was cured in 10 cases (10 / 10) and the cure rate was 100%. 5 cases were cured after corneal foreign body was removed and perforated or nearly perforated. The cure rate of infectious corneal ulcer was 100. The cure rate of infectious corneal ulcer was significantly different from that of non-infectious corneal disease (P 0.05). The cure rate of noninfectious corneal diseases was significantly higher than that of infectious corneal diseases. The therapeutic effect of non-acute suppurative corneal ulcer (herpes simplex corneal ulcer) is better than that of acute suppurative corneal ulcer (fungi). Complications occurred in 21 cases (21 eyes), including 11 cases of partial dissolution of conjunctival flap, 4 cases of perforation of conjunctival flap and 4 cases of slippage of conjunctival flap. Complications occurred in 20 cases (16.9%) after operation and 1 case (2.3%) after operation for non-infectious corneal diseases. There was significant difference in the incidence of complications between the two groups (P 0.05). The incidence of complications in non-infectious corneal diseases was significantly lower than that in infectious corneal diseases. Conclusion: conjunctival flap covering surgery is effective in the treatment of various types of refractory corneal diseases. The therapeutic effect of noninfectious keratopathy is better than that of infective keratopathy. For acute suppurative corneal ulcer, targeted treatment before operation may help to improve the success rate of operation.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R779.6

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