Clinical observation of therapeutic efficacy and study of conjunctival impression cytology after pterygium surgery

目的 观察翼状胬肉不同术式后眼表的病理学变化,同时对比观察不同术式的复发和眼表损伤情况,为临床医师设计针对性治疗方法提供理论依据.方法 前瞻性研究.筛选2006年3月至2008年3月于石家庄市中心医院眼科就诊的原发性翼状胬肉患者84例(93只眼),按患者的临床特点分为4组:单纯翼状胬肉切除组24例(27只眼)、自体结膜移植组21例(22只眼)、自体角膜缘干细胞移植组18例(20只眼)、单纯翼状胬肉切除加用0.02%丝裂霉素c(MMC)组21例(24只眼).分别于术前1 d、术后30 d、术后90 d应用醋酸纤维膜滤纸片取4组患者眼表结膜上皮组织,行结膜印记细胞学对杯状细胞、炎性细胞等进行定性检查,同时观察术眼有无异物感、眼睑红肿、结膜水肿、角膜创面愈合情况、复发倾向等指标.采用多变量方差分析对实验结果进行统计学分析.结果 4组患者术前胬肉区结膜上皮细胞可见上皮细胞角化较轻,细胞间隙加大,杯状细胞减少,4组杯状细胞密度分别为248.8±97.3,256.2±75.1,236.1±87.9,245.1±81.0,差异元统计学意义(F=0.029,P=0.993).术后1个月,所有患者上皮细胞角化减轻,细胞间隙减小,核质比减少;术中加用MMC组杯状细胞数较其他3组有所增加,但差异无统计学意义(F=0.747,P=0.554).术后3个月,加用MMC组,上皮细胞角化加重,细胞间隙增加,核质比增加,杯状细胞数明显减少,密度为112.1±56.8,与其他3组(309.6±77.0,314.1±68.9,317.4±73.2)相比差异有统计学意义(F=6.337,P=0.017),但另外3组之间差异无统计学意义.4组患者中单纯翼状胬肉组5例复发;自体结膜移植组无1例复发;干细胞移植组1例复发;单纯切除加用MMC组3例复发.结论 翼状胬肉切除联合自体结膜移植和翼状胬肉切除联合角膜缘干细胞移植较单纯切除均能有效地降低复发率,有效促进创面愈合,改善眼表状态.MMC对眼表环境有明显的损伤.Objective To compare the pathologic changes,the recurrence rate and the ocular surface damage after 4 different types of pterygium surgical procedures.Methods It is a prospective study.From Mar.2006 to Mar.2008,84 patients (93 eyes) from Shi Jia-zhuang Center Hospital were selected and separated into 4 groups as follows,simple excision group,24 patients (27 eyes) ;excision with conjunctival allograft group,21 patients(22 eyes) excision with autologous limbus stem cell transplantation group,18 patients (20 eyes) and excision with mitomycin (MMC) group,21 patients (24 eyes).Slit lamp microscope examination and impression cytology were performed 1 day before the surgery and repeated 30 and 90 days after the surgery.Multivariate analysis of variance was used to analyze these data with statistical software SPSS 11.0.P value less than 0.05 was considered statistically significant.Results Before the surgery,slight conjunctival epithelium keratinization,mild acantholysis and decrease in goblet cells density were identified in all patients(248.8 ±97.3,256.2 ±75.1,236.1 ±87.9,245.1 ±81.0;F=0.029,P =0.993).All of these changes decreased 1 month after the surgery.MMC group showed more goblet cells than the other 3 groups,but the difference was not statistically significant (F = 0.747,P = 0.554).Three months after the surgery,all of these changes in MMC group(112.1 ±56.8) were significantly more severe than those in other 3 groups (309.6±77.0,314.1 ±68.9,317.4 ±73.1;F = 6.337,P =0.017) and no difference could be detected between these 3 groups.There were 5 recurrences in simple excision group,3 recurrences in MMC group,1 recurrence in stem cell transplantation group and none in conjunctival allograft group.Conclusions There are fewer recurrent cases in conjunctival allograft group and stem cell transplantation group than the others.Severe ocular surface damage is present in MMC group.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)04323-3274