2型糖尿病患者不同翼状胬肉手术方式的疗效比较及其对泪膜的影响

Effect of different types of pterygium surgery and on tear film in patients with type 2 diabetes mellitus

摘要:

目的：比较2型糖尿病患者三种不同翼状胬肉手术方式的疗效及其对泪膜的影响。

方法：回顾分析我院2013-03/2016-03期间收治的手术治疗的翼状胬肉合并2型糖尿病患者102例102眼。其中行翼状胬肉单纯切除术34例34眼(单纯切除组)； 胬肉切除联合自体结膜瓣移植术34例34眼(球结膜瓣组)； 胬肉切除联合角膜缘干细胞移植术34例34眼(干细胞组)。观察三组患者术后伤口修复时间、并发症、裸眼视力、复发率以及手术前、手术后6、12mo三组患者泪膜破裂时间(BUT)、基础泪液分泌试验(SⅠt)。

结果：术后三组患者视力均较术前明显提高(P=0.039、0.013、0.024)，且三组间比较无统计学差异(P=0.317)。术后单纯切除组伤口修复时间为5.67±1.45d，明显大于球结膜瓣组(4.18±0.76d)与干细胞组(4.09±0.79d)，差异有统计学意义(P<0.001)； 而结膜瓣组与干细胞组比较无统计学差异(P=0.937)。术后单纯切除组有4例复发，复发率为11.8%，明显高于其它两组(P=0.037)，球结膜瓣组有1例复发，复发率为2.9%，而干细胞组未见明显复发患者。术后SⅠt和BUT均明显增加(P<0.05)，尤其是结膜瓣组和干细胞组增加比较显著(P<0.001)。而球结膜瓣组和干细胞组间无统计学差异(P=0.845、0.894)。

结论：翼状胬肉切除联合结膜瓣移植和角膜缘干细胞移植对于治疗血糖和泪膜功能正常的2型糖尿病患者具有相似的疗效及术后泪膜功能，且优于单纯翼状胬肉切除术。

Abstract:

AIM:To compare the effect of three types of pterygium surgery and on tear film in patients with type 2 diabetes mellitus.

METHODS:A total of 102 patients(102 eyes)with pterygium combined with type 2 diabetes mellitus treated in our hospital from March 2013 to March 2016 were analyzed retrospectively. The patients were divided into three groups including the 34 cases(34 eyes)with simple excision of pterygium(resection group), pterygium excision combined with conjunctival flap transplantation in 34 cases(34 eyes, as conjunctival flap group)and pterygium excision combined with limbal stem cell transplantation in 34 cases(34 eyes, as stem cell group). The wound repair time, complications, recurrence rate, uncorrected visual acuity(UCVA), tear film break-up time(BUT)and basal tear secretion test(SⅠt)were observed before, and 6 and 12mo after surgery in the three groups, respectively.

RESULTS: The postoperative UCVA of the three groups was significantly higher than that preoperation(P=0.039, 0.013, 0.024), and there was no significant difference among the three groups(P=0.317). The wound repair time was 5.67±1.45d in the resection group, which was significantly higher than that in the conjunctival flap group(4.18±0.76d)and the stem cell group(4.09±0.79 d)(P<0.001), there was no significant difference between the conjunctival flap group and the stem cell group(P=0.937). There were 4 cases in resection group reappeared, and the recurrence rate was 11.8%, which was significantly higher than the other two groups(P=0.037). There were 1 recurrences in the conjunctival flap group, and the recurrence rate was 2.9%, while the patients in the stem cell group had no obvious recurrence. SⅠt and BUT increased significantly after operation(P<0.05), especially in conjunctival flap group and stem cell group(P<0.001). There was no significant difference between the conjunctival flap group and the stem cell group(P=0.845, 0.894).

CONCLUSION: Pterygium excision combined with conjunctival flap transplantation or limbal stem cell transplantation for the treatment of type 2 diabetic patients with normal blood glucose and tear film function has the similar effect, and is better than simple pterygium excision.