冷冻保存的纤维蛋白胶粘合植片技术在翼状胬肉手术中的应用  

Application of cryopreserved fibrin glue for fixation of conjunctival autograft in pterygium surgery

作　　者：龚静文[1] 方丽华[1] 贺金晶 蒋劲[1] GONG Jingwen;FANG Lihua;HE Jinjing(Department of Ophthalmology,Zhejiang Provincial People’s Hospital(People’s Hospital of Hangzhou Medical College),Hangzhou 310014,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)眼科,310014

出　　处：《浙江医学》2020年第10期1034-1037,1047,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目 (2018PY003)。

摘　　要：目的评估冷冻保存的纤维蛋白胶(FG)联合角膜缘干细胞移植在翼状胬肉治疗中的有效性及安全性。方法纳入36例原发性鼻侧翼状胬肉患者,采用抛硬币法将患者随机分为6组,将自行配制的FG分装至无菌Eppendorf管内,在-20℃下分别冷冻保存3、7、14d及1、2、3个月。随机抽取每个保存时间点的纤维蛋白原溶液(F)和凝血酶溶液(C)各3管,送至微生物实验室进行细菌培养及细菌计数。每组患者使用相应保存时间的自行配制的FG来固定干细胞移植片。术后1、3、7、14d及1、3、6个月对患者进行随访,主要观察指标包括手术时间、移植片固定次数、患者术后不适症状、角膜上皮完全愈合时间、术后并发症及复发率。结果所有不同时间保存的分装F管、C管均未培养出细菌。有4例患者需要二次使用FG固定移植片,各组患者移植片固定次数比较差异无统计学意义(P>0.05)。各组患者术后1、3、7d不适症状评分比较差异均无统计学意义(均P>0.05)。各组患者角膜上皮完全愈合时间比较差异无统计学意义(P>0.05)。总的胬肉复发率为5.6%,各组患者胬肉复发率比较差异无统计学意义(P>0.05)。结论在翼状胬肉手术中,应用自行配制的冷冻保存的FG固定移植片是安全、有效的。自行配制FG并采用分装、冷冻保存技术可以将材料费用降至最低。Objective To evaluate the efficacy and safety of cryopreserved fibrin glue in limbal stem cell transplantation for patients with pterygium.Methods Thirty six patients(36 eyes)with primary nasal pterygium were randomly divided into 6 groups with 6 cases in each group.The self-prepared fibrin glue(FG)was subpackaged and cryopreserved for 3,7,14 d and 1,2 and 3 months at-20℃(groups 1-6),respectively;the asepsis of FG was confirmed by bacterial culture and colony counting at different time points.The corresponding self-prepared FG was applied to fix the autograft after the pterygium was removed in 6 groups.All the patients were followed up on d3,7 and 14,then on months 1,3 and 6.The operating time,fixation success rate,corneal healing,postoperative symptoms,recurrence rate and complications were observed and compared among 6 groups.Results The bacteria cultures were negative in all the fibrinogen and thrombin solutions.Four cases needed a second try with self-prepared FG during the autograft fixation,and there was no significant difference in times of FG use among 6 groups(P>0.05).There was no significant difference in postoperative discomfort among the groups on d1,3,7(all P>0.05).There was no significant difference in the healing time of corneal epithelium among the groups(P>0.05).The total recurrence rate of pterygium surgery was 5.6%.There was no significant difference in the recurrence rate among the groups(P>0.05).Conclusion Self-prepared FG is safe and effective for autograft fixation in pterygium surgery.It can reduce the material cost of FG through the technology of subpackage and cryopreservation.

关 键 词：纤维蛋白胶 冷冻保存 翼状胬肉 粘合 

分 类 号：R779.6[医药卫生—眼科]