钝性分离联合成体干细胞结膜瓣移植治疗复发性翼状胬肉患者的临床疗效  

Efficacy of blunt dissection plus conjunctival autograft with adult stem cell transplantation for patients with recurrent pterygium

作　　者：承伟[1] 浦利军 徐玉莲[1] 姜莹莹[1] 臧亚芳[1] CHENG Wei;PU Lijun;XU Yulian;JIANG Yingying;ZANG Yafang(Department of Ophthalmology,the Affiliated Zhangjiagang Hospital of Soochow University,Zhangjiagang 215600,Jiangsu Province,China)

机构地区：[1]苏州大学附属张家港医院眼科,江苏省张家港市215600

出　　处：《眼科新进展》2020年第9期853-856,共4页Recent Advances in Ophthalmology

基　　金：江苏省张家港市科技支撑计划(社会发展)项目(编号:ZKS1831)。

摘　　要：目的探讨钝性分离联合成体干细胞结膜瓣移植对复发性翼状胬肉患者眼部症状评分(OSS)、视觉模拟评分(VAS)和角膜Shimmura评分的影响。方法选取于我科行复发性翼状胬肉手术患者53例53眼。按照手术分离方式分为钝性组26眼和常规组27眼,前者行钝性分离,后者行常规分离,术中均移植成体干细胞结膜瓣。术后,采用OSS、VAS和角膜Shimmura评分,评价钝性分离联合成体干细胞结膜瓣移植对复发性翼状胬肉患者的临床疗效。结果术后1 d、3 d、5 d、7 d,钝性组OSS、VAS、角膜Shimmura评分均低于常规组且随时间而降低,差异均有统计学意义(均为P<0.05)。术后14 d,钝性组OSS 1分者1眼、常规组1分者3眼,其余均为0分,两组间差异无统计学意义(P>0.05)。同期VAS钝性组有1眼1分,为之前最高分者;常规组有2眼1分,1眼3分,非之前最高分者,两组间差异无统计学意义(P>0.05)。术后14 d,两组角膜Shimmura评分均为0分。术后6个月,两组间复发情况差异无统计学意义(P=1.00)。结论钝性分离能避免锐性损伤,提供微创基面;钝性分离联合成体干细胞结膜瓣移植能更快地降低术后早期自觉症状与眼痛,促进眼表重建。Objective To investigate the efficacy of blunt dissection with diluted dehydrated alcohol plus conjunctival autograft with adult stem cell transplantation on ocular symptom scores(OSS),visual analogue scale(VAS)and corneal Shimmura’s scores of patients with recurrent pterygium.Methods We included only randomized controlled trials(RCTs)in which 53 patients(53 eyes)undergoing recurrent pterygium surgery.According to the operation types,26 eyes received blunt dissection as blunt group,27 eyes by conventional surgery as conventional group.For each affected eye,pterygium excision plus conjunctival autograft with adult stem cell was performed.The postoperative subjective symptom was measured by OSS,ophthalmodynia was surveyed by VAS,and ocular surface reconstruction was assessed with corneal Shimmura’s scores.Results On day 1,3,5,7 postoperatively,the OSS,VAS,and corneal Shimmura’s scores of the blunt group were lower than those of the conventional group,and they decreased over time.The difference was statistically significant(all P<0.05).On day 14 postoperatively,4 patients had 1 point of the OSS,including 1 in the blunt group,3 in the conventional group,and the rest was 0;no significant difference between the two groups was found(P>0.05).There was only 1 patient left in the blunt group with 1 point of the VAS at the same day,who was the one with the highest scores postoperatively;2 patients with 1 point and 1 patient with 3 point left in the conventional group,who were not those with the highest point postoperatively,and the difference between the two groups was not statistically significant(P>0.05).The mean value of the corneal Shimmura’s scores of both groups was 0 point on day 14.At 6 months after operation,there was no significant difference in recurrence between the two groups(P=1.00).Conclusion Blunt dissection can avoid cutting injuries and offers minimally invasive corneal surface;blunt dissection combined conjunctival autograft with adult stem cell transplantation to recurrent pterygium ameliorates t

关 键 词：钝性分离 复发性翼状胬肉 成体干细胞 眼表重建 自觉症状 

分 类 号：R777.33[医药卫生—眼科]