低温等离子手术系统在翼状胬肉切除术中应用疗效研究  

Application of the low-temperature plasma surgical system in pterygium excision

作　　者：孙珊珊 吴德 陈娟 孙倬[1] SUN Shan-shan;WU De;CHEN Juan;SUN Zhuo(Department of Ophthalmology,the Third People’s Hospital of Changzhou,Changzhou 213001,China)

机构地区：[1]常州市第三人民医院眼科,江苏常州213001

出　　处：《创伤与急危重病医学》2024年第1期50-54,共5页Trauma and Critical Care Medicine

基　　金：江苏省卫生健康委医学科研(指导性)项目(Z2022063);常州市卫健委科技项目(青年人才)(QN202239)。

摘　　要：目的 探讨低温等离子手术系统在翼状胬肉切除联合角膜缘干细胞自体结膜移植术中的应用和临床效果。方法 回顾性分析自2020年3月至2022年3月常州市第三人民医院眼科接受手术治疗的46例(54眼)原发性翼状胬肉患者临床资料,手术方式均为翼状胬肉切除联合带角膜缘干细胞的自体结膜移植术,术中应用低温等离子手术系统进行胬肉头部切除及止血。记录术后角膜上皮愈合时间;术前及术后1、3、6、12个月的最佳矫正视力(BCVA)、泪液分泌试验(SIT)、泪膜破裂时间(BUT)、泪河高度;术后并发症及复发率。结果 术后1周,所有患者角膜上皮均愈合,愈合时间(5.7±1.0)d。术后各时间点的BCVA均较术前改善,且术后3、6、12个月的BCVA较术后1个月明显改善,差异有统计学意义(P<0.05)。术后3、6、12个月的BCVA比较,差异无统计学意义(P>0.05)。术后各时间点的SIT、BUT、泪河高度均较术前提高,且术后1、3、6、12个月的SIT、BUT、泪河高度逐渐升高,各时间点比较,差异均有统计学意义(P<0.05)。1例患者于术后2周出现结膜瓣坏死、巩膜溶解现象,经积极的羊膜移植术治疗后得到治愈。患者术后均未出现复发,有2例患者分别在术后3个月和6个月切除区出现增生纤维组织,但尚未侵及透明角膜。结论 翼状胬肉切除联合带角膜缘干细胞的自体结膜移植术有利于改善患者术后视力、促进泪膜功能恢复和减少角膜上皮愈合时间,且复发率低。低温等离子射频消融术在翼状胬肉切除术中,可达到组织切割、止血的双重作用,并减轻术中对组织的损伤,有利于术后眼表环境的修复和重建。Objective To analyze the application of low-temperature plasma surgical system in pterygium excision combined with limbal stem cell autologous conjunctival transplantation and clinical effect.Methods A total of 46 cases with 54 eyes of primary pterygium patients who received surgical treatment in the Third People’s Hospital of Changzhou Ophthalmology Department from March 2020 to March 2022 were retrospectively analyzed.The surgical methods were pterygium excision combined with limbal stem cell autologous conjunctival transplantation.The low-temperature plasma surgical system was used to excise the pterygium head and hemostasis during the operation.Observation indicators included the corneal epithelium healing time after the surgery,the best corrected visual acuity(BCVA)and the change of tear film function,such as Shirmer-I test(SIT),break-up time(BUT)and lacrimal river height,before and 1,3,6,12 months after the surgery.Postoperative complications and postoperative recurrence rate were observed simultaneously.Results The corneal epithelium completely healed in all eyes one week after the surgery,and the healing time was(5.7±1.0)d.Compared with preoperative,the BCVA after the surgery was improved,and BCVA at 3,6 and 12 months after the surgery was significantly improved compared with 1 month after the surgery,with statistical significance(P<0.05).There was no significant difference in BCVA at 3,6 and 12 months after the surgery(P>0.05).After the surgery,the SIT,BUT and lacrimal river height were improved compared with those before the surgery,and the SIT,BUT and lacrimal river height at 1,3,6 and 12 months after the surgery were gradually increased,with statistical significance(P<0.05).One patient had conjunctival flap necrosis and scleral lysis at 2 weeks after the surgery,and was cured after active amniotic membrane transplantation.None of the patients had recurrence after the surgery.There were 2 patients with hyperplasia of fibrous tissue in the resection area at 3 months and 6 months after the surgery,res

关 键 词：翼状胬肉 角膜缘干细胞 结膜移植术 低温等离子 泪膜 

分 类 号：R779.6[医药卫生—眼科]