摘要
目的:传统的翼状胬肉切除术复发率高,自体角膜缘移植应用于胬肉切除术是近年来开展的术式,取材方便,安全。为寻求安全、有效的手术方式,降低术后复发率,文章对不同种族的翼状胬肉患者施行自体角膜缘干细胞移植联合翼状胬肉切除术,并观察分析其治疗结果。方法:①实验对象:选择2000-01/2006-06就诊的翼状胬肉患者198例(206眼),其中就诊于中国厦门者144例,均为初发病例;作者在非洲博茨瓦纳国接诊的黑种人患者54例,均为复发病例。患者对治疗方案及实验均知情同意,且得到医院伦理道德委员会批准。②实验方法:对198例患者施行自体角膜缘干细胞移植联合胬肉切除术,即切除胬肉组织后在术区覆盖取自颞上方球结膜的带角膜缘的薄层游离结膜瓣。③实验评估:通过术后随访,对手术区域进行分级评估,1级为术区外观正常,4级即胬肉复发。观察术后复发率及并发症出现情况。结果:随访时间6个月￣2年,平均14个月。①术后6周时未发现翼状胬肉复发,术后6个月时中国汉族人、博兹瓦纳黑种人病例的复发率分别为6.6%和14.8%,术后12个月时复发率分别为11.8%和24.5%。②术后6周时,两组病例的分级情况差异存在显著性意义(P<0.01),中国病例恢复较好。术后6个月及术后1年时两组术区分级差异无显著性意义(P>0.05)。③翼状胬肉患者术后并发症少,主要为角膜浅层瘢痕、持续性眼表刺激症状,无严重并发症出现。结论:显微镜下行自体角膜缘干细胞移植联合翼状胬肉切除术,具有切除胬肉较彻底、组织损伤小、术后反应轻、复发率较低的特点,有一定的实用价值。黑种人病例的术后复发率高于中国汉族翼状胬肉患者。
AIM: The relapse of traditional excision of pterygium is very high. Corneal limbal stem cell autograft is recently adopted in the excision of pterygium; it is simple and safety. In this study, corneal limbal stem cell autograft combined with excision of pterygium was used for people of different races and the curative effect was observed, so as to find an effective surgical therapy with low rate of recurrence. METHODS: ①198 patients (206 eyes) were selected from January 2000 and June 2006 including 144 primary cases from Xiamen and 54 relapsed Negro from Africa. The experiment was agreed by all the subjects and permitted by Hospital Ethics Committee. ②198 subjects were treated by corneal limbal stem cell autograft combined with excision of pterygium, in which a free transplantation of the superotemporal limbus with an adjacent piece of thin conjunctiva was placed in the excision area. ③All cases were post-operatively followed-up to grade the appearances of the sites after excision (grade 1 implied normal appearance, and grade 4 implied the relapse). The recurrence rates were also reported. RESULTS: Mean follow-up was 14 months (range, 6 months-2 years). ①No relapse was found at 6 weeks after operation. The recurrence rate of Chinese Han people and Africa Botswana Black people cases were 6.6% and 14.8% respectively at 6 months, and 11.8% and 24.5% at 12 months. ②There were significant differences in the appearances grading between two groups at 6 weeks (P < 0.01), and Chinese people recovered better. There was no statistical difference at 6 months and 12 months (P > 0.05). ③Few complications were found except superficial scaring of cornea and persistent irritation of ocular surface. No severe complication was found. CONCLUSION: Limbal stem cell autograft combined with excision of pterygium under microscope could completely remove pterygium with minimal invasion, light postoperative response and low rate of recurrence. The relapse of Negro is higher than Chinese patients.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第51期10362-10365,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
