目的：探讨翼状胬肉切除联合游离结膜瓣移植术治疗原发性翼状胬肉的疗效及对泪膜功能的影响。

方法：选择2018-01/2019-10我院收治的120例126眼原发性翼状胬肉患者作为研究对象，按照随机数字表法分为2组，结膜移植组62例64眼行翼状胬肉切除联合游离结膜瓣移植术治疗，羊膜移植组58例62眼行翼状胬肉切除联合羊膜移植治疗。测定术前，术后3、6mo时泪液分泌长度(SⅠt)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)评分、非侵入性首次泪膜破裂时间(NIBUT)、泪河高度(TMH)、结膜杯状细胞数量，采用眼表疾病指数(OSDI)评估患者生活质量，于术后6mo时评估治疗效果及复发情况。

结果：结膜移植组及羊膜移植组患者角膜上皮平均修复时间、症状持续时间比较均无差异(P>0.05)。术后6mo结膜移植组患者BUT(11.11±2.77s vs 10.01±2.41s)、NIBUT(10.01±1.52s vs 9.52±0.98s)高于羊膜移植组(P<0.05)，FL评分(0.44±0.10分 vs 0.50±0.11分)低于羊膜移植组(P<0.05)。术后两组患者结膜杯状细胞数量均明显增加(P<0.05)，术后3、6mo时结膜移植组患者结膜杯状细胞数量多于羊膜移植组(311.41±58.45/mm²vs 285.46±68.96/mm²，342.41±66.89/mm²vs 314.41±70.12/mm²，均P<0.05)。术后两组患者OSDI评分均显著降低(P<0.05)，结膜移植组、羊膜移植组患者OSDI评分组间无差异(P>0.05)。两组患者总体疗效无差异(P>0.05)； 结膜移植组及羊膜移植组患者复发率分别为6.3%、6.5%，组间无差异(P>0.05)。

结论：翼状胬肉切除联合自体结膜瓣移植在术后恢复及预防翼状胬肉复发方面与羊膜移植相当，对患者泪膜功能稳定性有更好的改善效果。

METHODS:Totally 120 patients(126 eyes)with primary pterygium who were admitted to the hospital between January 2018 and October 2019 were selected as the research subjects. They were divided into two groups according to the random number table method. 62 cases(64 eyes)in the conjunctival transplantation group were treated with pterygium excision combined with free conjunctival flap transplantation. 58 cases(62 eyes)in the amniotic membrane transplantation group were treated with pterygium excision combined with amniotic membrane transplantation. The length of Schirmer's-Ⅰ test(SⅠt), tear film break-up time(BUT), corneal fluorescein staining(FL)scores, noninvasive Keratograph tear breakup time(NIBUT), determine tear river height(TMH)and conjunctival goblet cell count were determined before surgerry, at 3mo and 6mo after surgery. Patients' quality of life was evaluated with ocular surface disease index(OSDI), and the therapeutic effect and recurrence were evaluated at 6mo after surgery.

RESULTS: There was no significant difference in the average repair time of corneal epithelium or the duration of symptoms between the conjunctival transplantation group and the amniotic membrane transplantation group(P>0.05). At 6mo after surgery, the BUT \〖(11.11±2.77)s vs(10.01±2.41)s\〗, NIBUT \〖(10.01±1.52)s vs (9.52±0.98)s\〗 in conjunctival transplantation group was longer than that in the amniotic membrane transplantation group(P<0.05), and the FL score was lower than the amniotic membrane transplantation group \〖(0.44±0.10)points vs(0.50±0.11)points\〗(P<0.05). The conjunctival goblet cell counts in both groups were increased significantly after surgery(P<0.05). At 3mo and 6mo after surgery, the counts in conjunctival transplantation group were larger than those in the amniotic membrane transplantation group \〖(311.41±58.45)/mm² vs(285.46±68.96)/mm²,(342.41±66.89)/mm² vs(314.41±70.12)/mm²\〗(P<0.05). The OSDI scores of both groups were significantly decreased after surgery(P<0.05), but there was no significant difference between groups(P>0.05). There was no statistically significant difference in the overall curative effect between the two groups(P>0.05). The recurrence rates in the conjunctival transplantation group and the amniotic membrane transplantation group were 6.3% and 6.5%, respectively(P>0.05).

CONCLUSION: Pterygium resection combined with autologous conjunctival flap transplantation is equivalent to amniotic membrane transplantation in terms of postoperative recovery and prevention of pterygium recurrence. Both can improve the stability of patients' tear film function.