不同手术干预的选择是否会影响翼状胬肉的复发？
Does Choice of Different Surgical Intervention Play a Role in the Recurrence of Pterygium?
机构信息
Sagarmatha Choudhary Eye Hospital, Lahan, Nepal.
Taparia Eye Hospital, Biratnagar, Nepal.
出版信息
Kathmandu Univ Med J (KUMJ). 2023 Jul-Sep;21(83):254-259.
Background There are a wide range of pterygium excision techniques in practice. However, choosing the best possible option is an important factor to prevent its recurrence. Objective To compare the recurrence rate of different excision techniques and understand if a surgeon can alter the recurrence rate. Method A retrospective data of pterygium surgeries operated by a surgeon at Sagarmatha Choudhary Eye Hospital, Nepal from the year 2016 to 2018 was investigated for recurrence. The recurrence was measured by an independent Optometrist with the help of clinical photo and slit-lamp examination. A telephonic directory was maintained for every patient's follow up reminder. Result Altogether 916 individuals with mean age 56.20 years had undergone pterygium excision. Bare Sclera 280 (30.56%), Pterygium Extended Conjunctival Transplantation (PERFECT) 305 (33.29%), Conjunctival auto graft (CAG) 262 (28.60%), Simple Pterygium excision 60 (6.55%) and Amniotic Membrane Graft (AMG) 9 (0.98%), jointly formed the total study sample and surgical techniques. Recurrence for Bare sclera was 172 (61.42%), simple pterygium excision 34 (56.66%), Pterygium extended conjunctival transplantation 0 (0%), and conjunctival auto graft 2 (0.76%). Compared conjunctival auto graft with pterygium extended conjunctival transplantation and simple pterygium with bare sclera revealed similar recurrence rate comparatively. The p-value obtained were p = 0.2148 and p = 0.8152 (p > 0.05, 95% CI) respectively. Conclusion The loss of limbal stem cells in Bare sclera technique acts as stimulant for pterygium recurrence, in addition the remains of pterygial matter in simple pterygium excision acts as precursor for recurrence. Pterygium extended conjunctival transplantation indeed acts as barrier but needs fine surgical skills to perform. Conjunctival auto graft can be opted as an alternative technique for minimal recurrence as compared to Pterygium extended conjunctival transplantation.
背景
目前临床上有多种翼状胬肉切除术技术。然而，选择最佳的术式是预防其复发的重要因素。目的：比较不同切除术式的复发率，并探讨术者是否可以改变复发率。方法：对 2016 年至 2018 年在尼泊尔萨加玛塔·乔杜里眼科医院由同一位医生进行的翼状胬肉手术患者的回顾性数据进行调查，以了解复发情况。由独立的验光师通过临床照片和裂隙灯检查来测量复发情况。为每位患者建立了电话目录以提醒随访。结果：共有 916 名平均年龄为 56.20 岁的患者接受了翼状胬肉切除术。单纯性巩膜切除术 280 例（30.56%）、翼状胬肉扩展结膜移植术（PERFECT）305 例（33.29%）、结膜自体移植术（CAG）262 例（28.60%）、单纯性翼状胬肉切除术 60 例（6.55%）和羊膜移植术（AMG）9 例（0.98%），联合形成了本研究的总样本和手术技术。单纯性巩膜切除术的复发率为 172 例（61.42%），单纯性翼状胬肉切除术的复发率为 34 例（56.66%），翼状胬肉扩展结膜移植术的复发率为 0（0%），结膜自体移植术的复发率为 2 例（0.76%）。与单纯性巩膜切除术和翼状胬肉扩展结膜移植术相比，结膜自体移植术与单纯性翼状胬肉切除术的复发率相似。获得的 p 值分别为 p=0.2148 和 p=0.8152（p>0.05，95%CI）。结论：单纯性巩膜切除术丢失角膜缘干细胞会刺激翼状胬肉复发，单纯性翼状胬肉切除术残留的翼状胬肉体组织会成为复发的前体。翼状胬肉扩展结膜移植术确实可以作为一种屏障，但需要精细的手术技能。与翼状胬肉扩展结膜移植术相比，结膜自体移植术可以作为一种复发率较低的替代技术。
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