两种不同缝线方法治疗原发性翼状胬肉的疗效比较

doi:10.3760/cma.j.cn115909-20191224-00347

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摘要目的：观察2种不同缝线方法治疗原发性翼状胬肉的临床疗效。方法：前瞻性研究。选取2015年4月至2018年4月于解放军乌鲁木齐市第474医院住院并手术的翼状胬肉患者128例(128眼)，采用随机数字表法随机分成观察组和对照组，每组64例（64眼）。观察组采用翼状胬肉切除联合连续缝合自体结膜瓣移植治疗，对照组采用翼状胬肉切除联合间断缝合自体结膜瓣移植治疗。观察2组术后1、3、 7 d的疼痛、角膜刺激症状程度；角膜荧光染色确定2组角膜上皮完全愈合时间；6个月随访中记录结膜完全愈合、瘢痕纤维增生及胬肉复发情况。2组间各指标的比较采用独立样本t检验；2组间率的比较采用卡方检验（必要时辅以Fisher精确概率法直接计算P值）。结果：疼痛和刺激症状评分方面，观察组术后1 d和3 d均低于对照组（疼痛评分：t=-40.477，P<0.001；t=-23.376，P<0.001。刺激症状评分： t=-18.431，P<0.001；t=-7.894，P<0.001)，术前和术后7 d，2组间差异无统计学意义。角膜荧光染色显示角膜上皮完全愈合率方面，观察组术后3 d和5 d均高于对照组（χ2 =4.354，P=0.037；χ2 =13.333， P<0.001），术后7 d组间差异无统计学意义。观察组的痊愈率高于对照组（χ2 =8.848，P=0.003），观察组的瘢痕痊愈率低于对照组（χ2 =8.214，P=0.004），2组胬肉复发率差异无统计学意义。观察组拆线时间早于对照组（t=-32.686，P<0.001），拆线耗时短于对照组（t=-20.236，P<0.001），拆线疼痛评分低于对照组（t=-26.580，P<0.001），差异均有统计学意义。结论：翼状胬肉切除联合连续缝合自体结膜瓣移植治疗原发性翼状胬肉，术后眼部疼痛、刺激、炎症反应轻，角膜上皮愈合更快，可明显减少瘢痕的形成，术后拆线更早，拆线耗时短且疼痛感较轻。

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关键词 ：原发性翼状胬肉, 自体结膜瓣移植, 连续缝合, 眼舒适度

Abstract：Objective: To study the clinical effect of two different suture methods in the treatment of primary pterygium. Methods: This was a prospective study of 128 patients (128 eyes) with pterygium who were hospitalized and underwent surgery in the 474 Hospital of the People's Liberation Army from April 2015 to April 2018. Patients were randomly divided into two groups: The experimental group and the control group. The experimental group was treated with pterygium resection combined with a continuous suture of autograft conjunctival flap, while the control group was treated with pterygium resection combined with an intermittent suture of autograft conjunctival flap. Pain and corneal irritation in the two groups were monitored on the 1st, 3rd and 7th day after the operation. The amount of time for the corneal epithelium to heal completely was determined by corneal fluorescence staining. The complete healing of the conjunctiva, scar fiber hyperplasia and pterygium recurrence were recorded during a 6-month followup period. An independent samples t test was used to compare the indexes between the two groups; a Chisquare test was used to compare the rates between the two groups (direct calculation of the P value with the aid of an accurate probability method if necessary). Results: Scores for pain and corneal stimulation symptoms in the experimental group were lower than for those in the control group on the 1st and 3rd day after the operation (scores for pain: t=-40.477, P<0.001; t=-23.376, P<0.001; scores for corneal stimulation symptoms: t=-18.431, P<0.001; t=-7.894, P<0.001). Comparisons were made preoperatively and on the 7th day after the operation. There was no significant difference between the two groups. Corneal fluorescence staining 7 days after the operation showed that the experimental group had a higher complete healing rate for the corneal epithelium than the control group (χ2 =4.354, P=0.037; χ2 =13.333, P<0.001). There was no significant difference between the two groups. The healing rate of the experimental group was higher than that for the control group (χ2 =8.848, P=0.003), but the scar healing rate of the experimental group was slower than that of the control group (χ2 =8.214, P=0.004). There was no significant difference in the recurrence rate of pterygium between the two groups. Sutures were removed sooner in the experimental group than in the control group (t=-32.686, P<0.001). The pain score of the experimental group was lower than that of the control group (t=-26.580, P<0.001). Conclusion: For pterygium excision combined with continuous suture and conjunctival flap autograft for the treatment of primary pterygium, postoperative eye pain, irritation and inflammatory reaction are slight, corneal epithelial healing is faster, scar formation can be significantly reduced, postoperative suture removal is earlier, time is shorter and pain is slighter.

Key words： primary pterygium conjunctival autograft continuous suture eye comfort

收稿日期: 2019-12-24

基金资助:新疆维吾尔自治区卫生健康委技术推广项目（SYTG-201993）

通讯作者: 李鹏（ORCID：0000-0002-7365-3200），Email：freemanlp010@sina.com

引用本文:

雷代坤　董晓云　李霞　刘毅　周瑛　李鹏. 两种不同缝线方法治疗原发性翼状胬肉的疗效比较[J]. 中华眼视光学与视觉科学杂志, 2020, 22(8): 607-612. Daikun Lei, Xiaoyun Dong, Xia Li, Yi Liu, Ying Zhou, Peng Li. Study of the Curative Effect of Two Different Suture Methods in the Treatment of Pterygium. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(8): 607-612. DOI: 10.3760/cma.j.cn115909-20191224-00347

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20191224-00347 或 https://www.cjoovs.com/CN/Y2020/V22/I8/607

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