翼状胬肉切除术后巩膜融解并发症原因分析  

Analysis of the causes of complications in clinical scleral melting after pterygium excision

作　　者：何亚妮 李桂香 段直光 

机构地区：[1]大理州人民医院眼科,云南671000

出　　处：《中国实用眼科杂志》2014年第9期1110-1112,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的分析翼状胬肉切除术后发生巩膜融解并发症的原因和治疗。方法回顾性分析2008年8月至2013年5月在大理州人民医院眼科行翼状胬肉切除联合自体角膜缘干细胞移植的5例患者出现巩膜融解并发症的临床表现，并对该5例患者行血清学检查，于巩膜坏死区取材涂片及培养。治疗处置为首先停用典必舒眼药水，然后给予促进组织修复的贝复舒或重组人表皮生长因子眼液点眼，待有血管长入巩膜融解区时停用；其中2例巩膜深层融解范围较大行带蒂结膜瓣转位修复。结果5例患者取材培养均未见微生物生长。其中3例药物治疗2～3周于巩膜融解处可见血管及纤维组织生长，并逐渐有球结膜上皮组织覆盖；2例带蒂结膜瓣转位修复愈合良好。结论手术因素、自体免疫反应或超敏反应、眼表组织修复障碍，是导致翼状胬肉切除术后巩膜融解的主要原因。减少手术创伤与合理用药．可有效治疗和预防巩膜融解并发症的发生。Objective To analyze the causes and treatment of complications of scleral melting after pterygium excision. Methods Retrospective analysis of the clinical manifestations of 5 patients appeared scleral melting complications after received pterygium excision combined with autologous limbal stem cell transplantation in the Department of Ophthalmology of Dali People＇s Hospital from August 2008 to May 2013. The 5 patients underwent serological examination, and scleral necrosis area were smeared and cultured. Treatment： first stopped using TobraDex eye drops, and then gave recombinant bovine basic fibroblast growth factor eye drops or recombinant human epidermal growth factor eye drops to promote tissue repair and stopped using it when vessels entered the scleral melting zone. However, 2 cases with deep scleral melting range underwent pedicle conjunctival flap repair. Results There were no microbial growth in the culture. Among the 3 cases of drug treatment for 2-3 weeks, visible blood vessels and fibrous tissue growth in scleral melting area, and gradually conjunctival epithelium covering; the other 2 cases of pedicle conjunctival flap for the repair showed good healing. Conclusions The operation factors, autoimmune reaction or hypersensitivity, ocular surface tissue repair, is the main cause of scleral melting after pterygium excision. Reduce operation trauma and rational drug use, can produce effective treatment and prevention of complications of scleral melting.

关 键 词：翼状胬肉术后 巩膜融解 手术因素与免疫反应组织修复障碍 合理用药治疗 

分 类 号：R777.33[医药卫生—眼科]