CAJ | 학술논문

目的：探讨不使用丝裂霉素C（MMC）的羊膜移植联合带蒂结膜瓣移植术治疗复发性翼状胬肉的临床疗效。方法选取2010年1月至2013年6月于我院行羊膜移植联合带蒂结膜瓣移植术并经半年以上随访的复发翼状胬肉患者42例42眼，年龄26～74岁，观察期6～24个月。根据病例记载，对翼状胬肉有无复发、手术前后有无眼球运动障碍和睑球粘连、手术至复发的时间、术前既往手术次数等内容进行回顾性分析。结果42眼经长期随访观察，3级大胬肉的30眼中29眼（97％）未确认复发或复发后形成较小的胬肉，复发程度得到控制。同时，术前伴有睑球粘连和眼球运动障碍的病例术后分别有47％（17眼中8眼）和56％（25眼中14眼）得到改善。复发多见于术后6个月内，术后1年以上复发的仅有1例。在复发的8眼中有3眼（38％）需要再次手术。结论本术式未联合应用MMC ，在过去反复多次手术病例的81％中有效防止了复发。即使在复发的病例中胬肉的大小也得到了很好的控制。但仍有需要再次手术的病例，本术式也有一定的局限。存在重度睑球粘连和眼球运动障碍的病例有必要考虑联合MMC的术式。另外，应在根据客观检查判断睑球粘连和眼球运动障碍程度的基础上，结合复视这一主观检查作为术式选择时的指标。
목적：탐토불사용사렬매소C（MMC）적양막이식연합대체결막판이식술치료복발성익상노육적림상료효。방법선취2010년1월지2013년6월우아원행양막이식연합대체결막판이식술병경반년이상수방적복발익상노육환자42례42안，년령26～74세，관찰기6～24개월。근거병례기재，대익상노육유무복발、수술전후유무안구운동장애화검구점련、수술지복발적시간、술전기왕수술차수등내용진행회고성분석。결과42안경장기수방관찰，3급대노육적30안중29안（97％）미학인복발혹복발후형성교소적노육，복발정도득도공제。동시，술전반유검구점련화안구운동장애적병례술후분별유47％（17안중8안）화56％（25안중14안）득도개선。복발다견우술후6개월내，술후1년이상복발적부유1례。재복발적8안중유3안（38％）수요재차수술。결론본술식미연합응용MMC ，재과거반복다차수술병례적81％중유효방지료복발。즉사재복발적병례중노육적대소야득도료흔호적공제。단잉유수요재차수술적병례，본술식야유일정적국한。존재중도검구점련화안구운동장애적병례유필요고필연합MMC적술식。령외，응재근거객관검사판단검구점련화안구운동장애정도적기출상，결합복시저일주관검사작위술식선택시적지표。
Objective To investigate the clinical effect of amniotic membrane transplantation with autolo-gous conjunctival-flap transplantation without the use of mitomycin C for cases of recurrent pterygium .Methods Forty-two eyes of 42 patients (aged 26-74 years) with recurrent pterygium in our hospital from January 2010 to June 2013 underwent amniotic membrane transplantation with autologous conjunctival-flap transplantation were se-lected .Patients who did not undergo postoperative follow-up examination for at least 6 months were excluded . The follow-up time was 6-24 months .The recurrence of pterygium ,postoperative improvement of eye movement restriction and symblepharon ,the time interval between surgery and recurrence ,the number of prior surgeries were evaluated retrospectively from their medical records .Results Twenty nine of 30 eyes (97% ) with recurrent grade 3 pterygium didn′t recur or showed a reduction in the size of the new growth after surgery .The symblepha-ron improved postoperatively in 8 of 15 eyes (47% ) and restriction of eye movement improved in 14 of 25 eyes (56% ) .Most recurrences occurred within 6 months after surgery ,although 1 case did not show a recurrence until one year postoperatively .Conclusion Amniotic membrane transplantation with autologous conjunctival-flap trans-plantation without the use of mitomycin C reduced the size of the recurrent pterygium .However ,3 of the 8 eyes (38% ) required subsequent surgery , suggesting that the procedure has limitations . Therefore , mitomycin C should possibly be considered for patients with severe symblepharon or eye movement restriction .Diplopia can be an important indicator of the selection of surgical procedure.