曲安奈德淚阜下注射聯(lián)合翼狀胬肉切除術(shù)的臨床觀察

吳薔茵　于大仆

[摘要] 目的 探討曲安奈德淚阜下注射聯(lián)合翼狀胬肉切除術(shù)對(duì)控制術(shù)后復(fù)發(fā)的療效。 方法 選擇2016年1～11月期間收治26只翼狀胬肉眼，常規(guī)翼狀胬肉切除術(shù)后，曲安奈德注射液4 mg行淚阜下注射。觀察術(shù)后球結(jié)膜是否有結(jié)膜下翼狀胬肉樣組織增生及角膜愈合情況、角膜緣新生血管。 結(jié)果 術(shù)后1～2 d，26只眼均結(jié)膜平復(fù)、充血減輕、胬肉完全消退；角膜上皮修復(fù)、無(wú)新生血管、無(wú)胬肉增生。隨訪6～8個(gè)月，平均（7±2）個(gè)月，其中，26只眼復(fù)發(fā)1只眼，復(fù)發(fā)病例為3型。復(fù)發(fā)病例表現(xiàn)為：內(nèi)側(cè)結(jié)膜充血，結(jié)膜下翼狀胬肉樣組織增生，但侵入角膜小于2 mm。結(jié)論 曲安奈德注射液淚阜下注射對(duì)控制翼狀胬肉術(shù)后復(fù)發(fā)有一定療效。

[關(guān)鍵詞] 翼狀胬肉；淚阜；瞼裂斑；曲安奈德；新生血管

[中圖分類號(hào)] R779.6 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 1673-9701（2017）36-0067-04

[Abstract] Objective To investigate the curative effect of triamcinolone acetonide injection below the lacrimal caruncle combined with pterygium excision in controlling postoperative recurrence. Methods 26 eyes with pterygium from January to November in 2016 were selected. After conventional pterygium excision， 4 mg of triamcinolone acetonide injection was injected below the lacrimal caruncle into the lesion. Whether the bulbar conjunctiva had the subconjunctival pterygium-like tissue hyperplasia， corneal healing， limbal neovascularization were observed. Results At 1-2 days after surgery， the conjunctiva was flat， the congestion reduced and flesh completely subsided， corneal epithelial was repaired in 26 eyes， and there were no neovascularization or proliferation of pterygium. All the patients were followed up for 6-8 months， with an average of（7±2） months. Among them， 26 eyes had one case of recurrence with type 3. The manifestations of recurrence cases inluded medial conjunctival hyperemia， subconjunctival pterygium tissue-like proliferation， while the invasion of the cornea was less than 2 mm. Conclusion Triamcinolone acetonide injection below the lacrimal caruncle has some effect in controlling postoperative recurrence of pterygium.

[Key words] Pterygium； Lacrimal caruncle； Pinguecula； Triamcinolone acetonide； Neovascularizatin

翼狀胬肉是眼科的常見(jiàn)病，嚴(yán)重時(shí)不僅影響視功能，而且有礙美觀，目前無(wú)理想控制方法。翼狀胬肉是由增殖的球結(jié)膜侵襲到角膜上皮的病變組織，呈三角形，如翼狀。只限于瞼裂部，多見(jiàn)于鼻側(cè)，是纖維結(jié)締組織的變性。鼻側(cè)角膜緣相鄰處的球結(jié)膜侵襲到角膜上，呈三角形逐漸向角膜中央生長(zhǎng)，侵及前彈性層和淺基質(zhì)層。其尖端稱為頭，角膜緣處為頸，球結(jié)膜上為體。翼狀胬肉上有血管水平走行，進(jìn)行性的翼狀胬肉充血尤為顯著，組織肥厚，頭部前方角膜上有點(diǎn)狀浸潤(rùn)。主要治療方法是手術(shù)，但術(shù)后復(fù)發(fā)率高，復(fù)發(fā)的翼狀胬肉，因瘢痕組織增多，瞼球粘連，眼球運(yùn)動(dòng)障礙，手術(shù)更為困難，常需黏膜移植[1]，降低復(fù)發(fā)率的手術(shù)方法一直是翼狀胬肉手術(shù)研究的重要課題。……