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目的 评估广泛切除联合羊膜移植治疗翼状胬肉的效果。方法 对29例(30只眼)作翼状胬肉广泛切除联合羊膜移植手术,其中复发性胬肉8例8眼(26.7％),原发巨大胬肉7例7眼(23.3％),29例中双眼胬肉者20例(69.0％)。另有10例10眼作单纯广泛胬肉切除。广泛胬肉切除方法:作胬肉体部与球结膜潜行分离,并将胬肉与巩膜面和肌止部的粘连分离後,在半月皱襞处甚至连少许半月皱襞连同胬肉剪除,暴露巩膜面及肌止部,用深低温保存的羊膜行移植手术。缝合方法作了适当改进,即作间断固定缝合羊膜瓣,但角膜缘侧上下两角之间免除缝合。术後观察3～12个月。结果 (1)全部病例术後无复发,仅见一例巩膜面有薄层胬肉样的结膜增生。术後早期炎症反应或刺激,羊膜移植与单纯胬肉切除相似,拆线後羊膜移植病例眼部炎症反应消退快,1周内角膜上皮基本愈合,羊膜无F1染色,术後3～6个月羊膜移植区巩膜面清澈可见,无胬肉复发倾向。而单纯胬肉切除者刮面多有结膜血管与疤痕组织增生现象,并有2例胬肉复发。(2)视力改善程度:36.7％患者视力提高2～7行,63.3％患者视力同术前。(3)羊膜移植合并症:仅有一例羊膜下出血。结论 广泛胬肉切除联合羊膜移植治疗复发性胬肉、巨大胬肉等可有效防止复发,手术安全,并达到改善视力的目的。
Objective To assess the effect of extensive resection combined with amniotic membrane transplantation in the treatment of pterygium. Methods Thirty - nine eyes (26.7%) with recurrent pterygium, seven eyes (23.3%) with giant pterygium, and 29 cases (29 eyes) with giant pterygium were treated by extensive excision of pterygium with amniotic membrane transplantation in 29 patients (30 eyes) In the double-fold eyes of the meat in 20 cases (69.0%). Another 10 cases of 10 cases of simple extensive pterygium resection. Extensive pterygium excision method: for the psoas body and conjunctival sneak separation, and the pterygium and sclera and myocutaneous adhesions separated at the half-fold folds and even a little half-moon folds and pterygium cut off, exposing the sclera and Myocostasis, with cryogenic preservation of amniotic membrane transplantation. Suture method was appropriately improved, that is interrupted intermittently suture amniotic flap, but the corneal margin between the upper and lower corners of the suture. Postoperative observation of 3 to 12 months. Results (1) No recurrence was found in all cases, only one case had conjunctival hyperplasia of sclera with thin layer pterygium. Early postoperative inflammatory response or stimulation, amniotic membrane transplantation and simple resection of pterygium resection, stitches after amniotic membrane transplantation in patients with ocular inflammatory response subsided fast, corneal epithelial healed within 1 week, no amniotic F1 staining, 3 to 6 months after surgery Amniotic membrane transplantation area sclera surface is clear, no tendency to recurrence of pterygium. The simple pterygium excision scraping surface with more conjunctival blood vessels and scar tissue hyperplasia, and 2 cases of recurrence of pterygium. (2) The degree of vision improvement: 36.7% of patients with visual acuity increased by 2 to 7 lines, 63.3% of patients with visual acuity before surgery. (3) amniotic membrane transplantation complications: only one case of sub-amniotic hemorrhage. Conclusions The extensive pterygium excision combined with amniotic membrane transplantation for the treatment of recurrent pterygium, giant pterygium and so on can effectively prevent recurrence, operation safety, and achieve the purpose of improving vision.