發(fā)布時間：2018-03-10 18:45

  本文選題：翼狀胬肉　切入點：手術治療　出處：《山東大學》2016年碩士論文　論文類型：學位論文

【摘要】：研究背景：翼狀胬肉指的是局部的眼球球結膜和其下生成的纖維血管組織不斷增生,而且增生為三角形并膜樣。這種疾病會逐漸侵犯眼球,并且是慢性的眼表疾病,它的形狀通常呈像昆蟲的翅膀,因此多數情況下會被稱為“胬肉攀睛”或“攀睛”。迄今為止翼狀胬肉的具體發(fā)病原因仍然尚不明了,有學者認為可能與紫外線照射、接觸風塵等方面有一定的關系。翼狀胬肉發(fā)展呈進行性增大,由于對角膜的牽拉作用會引起角膜的屈光狀態(tài)改變,逐漸中心視力可受累,重者可嚴重影響視力,影響美觀。目前公認的對翼狀胬肉的治療方法是手術切除。但是一些傳統(tǒng)早期的單純胬肉切除術的手術術后復發(fā)率很高。近幾年由于手術方式的不斷改良,為該病的臨床治療提供了很多嶄新的治療途徑。近期我科探索出一種新的手術方式——翼狀胬肉切除術聯(lián)合結膜瓣反轉移植術。本研究擬比較自體結膜瓣反轉移植術與翼狀胬肉單純切除術及翼狀胬肉切除聯(lián)合干細胞移植術手術效果,以評估此種手術方式的可行性及臨床療效。研究方法：收集2014年8月至2015年4月在山東大學齊魯醫(yī)院眼科就診的61例(76只眼)靜止期翼狀胬肉患者(其中6例為復發(fā)性翼狀胬肉),隨機分為三組,分別采用翼狀胬肉單純切除術(A組23眼)、翼狀胬肉切除聯(lián)合干細胞移植術(B組28眼)和翼狀胬肉切除聯(lián)合結膜瓣反轉移植術(C組25眼),以角膜上皮術后恢復良好,可見光滑透明的角膜表面,且無明顯的新生血管和真性翼狀胬肉樣組織增生為治愈；以Prabhasawat分期4期(結膜充血明顯,手術區(qū)有新生血管和真性胬肉發(fā)生)視為復發(fā)。術后隨訪1年,分別在術后1、2week及1、2、3、4、6、12month復查,常規(guī)行裂隙燈檢查,患者視力及屈光度數檢查,從而比較三組患者術后效果。研究結果：數據采用t檢驗及兩樣本率比較的U檢驗等進行統(tǒng)計學處理。本研究共納入翼狀胬肉患者61例(76眼),其中男性32例(39只眼),女性29例(37只眼),年齡44-75歲,平均(60+10.7)歲,病程1-30年,平均(9.5+7.6)年,胬肉侵入角膜緣距離1～6mm,平均(3.42+1.45)mm。隨機將其分為A、B、C三組。翼狀胬肉單純切除術組(A組)復發(fā)6眼,復發(fā)率為26.1%,與其它兩組比較差異有顯著統(tǒng)計學意義(P0.05),翼狀胬肉切除聯(lián)合干細胞移植術組(B組)復發(fā)2眼,復發(fā)率為7.1%,翼狀胬肉切除聯(lián)合結膜瓣反轉移植術組(C組)復發(fā)1眼,復發(fā)率為4%,且B、C兩組比較差異無統(tǒng)計學意義(P0.05)。三組術前、術后裸眼視力及散光度數差異均有顯著統(tǒng)計學意義(P0.05),。B、C兩組術后1周內,出現(xiàn)植片充血水腫,充血時間為3-16天,平均8.82±4.62天,C組充血時間為3-21天,平均(10.56±6.14)天,兩組比較差異無統(tǒng)計學意義(P0.05),患者可有輕度畏光、流淚等不適。三組術后角膜表面逐漸光滑透明,A組角膜創(chuàng)面愈合時間為3～7天,平均(4.72±0.12)天,B組為2～6天,平均(3.27±0.96)天,C組為2-6天,平均(3.73±9.15)天。三組結果差異無統(tǒng)計學意義(P0.05)。A組1周拆除結膜縫線,B、C兩組視恢復情況術后1～2周拆線,眼刺激癥狀逐漸減輕至消失。B組拆線時間為7～20天,平均(15.13±3.68)；C組拆線時間為7-28天,平均(14.24±4.91)天。B組結膜瓣愈合時間為14～35天。平均(18.78±8.62)天；C組為21～68天,平均(35.08+13.37)天,兩組結果比較差異有顯著性差異(P0.01)。研究結論：翼狀胬肉切除聯(lián)合自體結膜瓣反轉移植術可有效治療翼狀胬肉,減小翼狀胬肉角膜散光,從而改善視功能,且無嚴重并發(fā)癥,是一種新型且有效的手術方式,但同時需要術者在手術過程中對結膜瓣的處理恰當而嚴謹,才能保證較低的術后復發(fā)率和避免更多并發(fā)癥的出現(xiàn)。
[Abstract]:Background: pterygium refers to eye conjunctival fibrovascular tissue generated locally and under the continuous proliferation and hyperplasia of triangular and membranous. The disease will gradually invaded eyeball, and chronic ocular surface disease, its shape is usually like the wings of an insect, so in most cases will be referred to "pterygium" or "crassum". So far the specific pathogenesis of pterygium still remains unclear, some scholars believe that may be related to ultraviolet radiation, there is a certain relationship between the contact dust and so on. Development of pterygium were increased due to corneal traction can cause corneal refractive changes gradually, central vision can be affected, they can seriously affect vision, affect the appearance of pterygium. Currently accepted treatment is surgical resection. But traditional early simple excision of pterygium hand The postoperative recurrence rate is very high. In recent years, due to the continuous improvement of surgical methods, provides a lot of new therapeutic approaches for the clinical treatment of the disease. Recently I, explore a new surgical method of pterygium excision combined with conjunctival flap transplantation. The anti transfer of this study was to compare the autogenous conjunctival flap anti metastasis transplantation and simple pterygium excision and excision of pterygium combined with stem cell transplantation surgery, the feasibility and clinical effect of surgical evaluation. The research methods: collected from August 2014 to April 2015 in Qilu Hospital of Shandong University on the diagnosis of 61 cases (76 eyes) quiescent pterygium patients (including 6 cases of recurrence pterygium), were randomly divided into three groups, respectively, using simple pterygium resection (group A, 23 eyes) of pterygium excision combined with stem cell transplantation (group B, 28 eyes) and pterygium excision combined with conjunctival flap Reverse transplantation (group C, 25 eyes) with corneal epithelium recovered well after operation, visible corneal surface smooth and transparent, and there is no obvious neovascularization and true pterygium tissue hyperplasia was cured; in Prabhasawat stage 4 (conjunctival congestion significantly, surgical area and neovascularization occurred as recurrent pterygium vera). Postoperative follow-up of 1 years, after the operation. 1,2week and 1,2,3,4,6,12month were underwent slit lamp examination, visual acuity and diopter check, in order to compare the three groups of patients with postoperative results. Results: compared with the data rate of t test and two sample U test was used for statistical analysis. 61 cases were included in this study pterygium patients (76 eyes), including 32 male patients (39 eyes), female 29 cases (37 eyes), aged 44-75, average (60+10.7), duration of 1-30 years, the average (9.5+7.6), pterygium from 1 ~ 6mm, average (3.42+1.45) with mm. 鏈哄皢鍏跺垎涓篈,B,C涓夌粍.緲肩姸鑳倝鍗曠函鍒囬櫎鏈粍(A緇，

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