本文選題：翼狀胬肉　切入點：手術(shù)治療　出處：《山東大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景：翼狀胬肉指的是局部的眼球球結(jié)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(shù)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(xué)者認(rèn)為可能與紫外線照射、接觸風(fēng)塵等方面有一定的關(guān)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(yán)重影響視力,影響美觀。目前公認(rèn)的對翼狀胬肉的治療方法是手術(shù)切除。但是一些傳統(tǒng)早期的單純胬肉切除術(shù)的手術(shù)術(shù)后復(fù)發(fā)率很高。近幾年由于手術(shù)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(shù)方式——翼狀胬肉切除術(shù)聯(lián)合結(jié)膜瓣反轉(zhuǎn)移植術(shù)。本研究擬比較自體結(jié)膜瓣反轉(zhuǎn)移植術(shù)與翼狀胬肉單純切除術(shù)及翼狀胬肉切除聯(lián)合干細(xì)胞移植術(shù)手術(shù)效果,以評估此種手術(shù)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(xué)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(fù)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(shù)(A組23眼)、翼狀胬肉切除聯(lián)合干細(xì)胞移植術(shù)(B組28眼)和翼狀胬肉切除聯(lián)合結(jié)膜瓣反轉(zhuǎn)移植術(shù)(C組25眼),以角膜上皮術(shù)后恢復(fù)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(jié)膜充血明顯,手術(shù)區(qū)有新生血管和真性胬肉發(fā)生)視為復(fù)發(fā)。術(shù)后隨訪1年,分別在術(shù)后1、2week及1、2、3、4、6、12month復(fù)查,常規(guī)行裂隙燈檢查,患者視力及屈光度數(shù)檢查,從而比較三組患者術(shù)后效果。研究結(jié)果：數(shù)據(jù)采用t檢驗及兩樣本率比較的U檢驗等進行統(tǒng)計學(xué)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(shù)組(A組)復(fù)發(fā)6眼,復(fù)發(fā)率為26.1%,與其它兩組比較差異有顯著統(tǒng)計學(xué)意義(P0.05),翼狀胬肉切除聯(lián)合干細(xì)胞移植術(shù)組(B組)復(fù)發(fā)2眼,復(fù)發(fā)率為7.1%,翼狀胬肉切除聯(lián)合結(jié)膜瓣反轉(zhuǎn)移植術(shù)組(C組)復(fù)發(fā)1眼,復(fù)發(fā)率為4%,且B、C兩組比較差異無統(tǒng)計學(xué)意義(P0.05)。三組術(shù)前、術(shù)后裸眼視力及散光度數(shù)差異均有顯著統(tǒng)計學(xué)意義(P0.05),。B、C兩組術(shù)后1周內(nèi),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(xué)意義(P0.05),患者可有輕度畏光、流淚等不適。三組術(shù)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(jié)果差異無統(tǒng)計學(xué)意義(P0.05)。A組1周拆除結(jié)膜縫線,B、C兩組視恢復(fù)情況術(shù)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(jié)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(jié)果比較差異有顯著性差異(P0.01)。研究結(jié)論：翼狀胬肉切除聯(lián)合自體結(jié)膜瓣反轉(zhuǎn)移植術(shù)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(yán)重并發(fā)癥,是一種新型且有效的手術(shù)方式,但同時需要術(shù)者在手術(shù)過程中對結(jié)膜瓣的處理恰當(dāng)而嚴(yán)謹(jǐn),才能保證較低的術(shù)后復(fù)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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