CAJ | 학술논문

目的探讨结膜松弛症发生发展与球结膜淋巴管扩张的关系.方法病例对照研究.上海中医药大学附属普陀医院眼科门诊2012年1月至3月就诊的60 ～ 80岁患者中,按结膜松弛症诊断标准连续入选100例作为研究对象；采用随机数字表法抽取100例非结膜松弛症的眼科患者作为临床对照组.用裂隙灯检查法观察球结膜淋巴管扩张情况,采用相干光断层成像(OCT)球结膜和筋膜图像扫描分析,手术切除淋巴管扩张区结膜组织病理学检查,并采用淋巴管特异性标记物D-240对组织进行免疫组织化学染色,Envision二步法鉴定.对各级结膜松弛症淋巴管扩张发生百分比进行x2检验,对结膜松弛症等级与球结膜淋巴管扩张的数据进行相关性分析.结果 100例(183只眼)结膜松弛症患者中伴有球结膜淋巴管扩张者29只眼,占15.84％；对照组100例(200只眼)球结膜淋巴管扩张者8只眼,占4.00％,两组差异有统计学意义(x2=15.36,P＜0.001).按照结膜松弛症分级标准:Ⅰ级中球结膜淋巴管扩张为8.60％,Ⅱ级中球结膜淋巴管扩张为12.96％,Ⅲ级中球结膜淋巴管扩张为37.03％,Ⅳ级中球结膜淋巴管扩张为44.44％.各级结膜松弛症淋巴管扩张发生百分比差异有统计学意义(x2 =18.61P＜0.001);结膜松弛症等级与球结膜淋巴管扩张发生有相关性(r =0.271,P＜0.001).OCT扫描淋巴管扩张多为球结膜上皮下,部分位于球结膜固有层,边界清楚,囊腔内充满液体,有单腔或多囊腔,未累及筋膜.11例组织病理学显示球结膜固有层轻微的慢性炎症改变伴有大量淋巴管扩张,扩张的淋巴管腔内充满粉红色淡染的淋巴液,淋巴管标记物证实扩张的管腔为淋巴管.结论球结膜淋巴管扩张可能是结膜松弛症发生发展的原因之一,随着结膜松弛症分级增高,球结膜淋巴管扩张发生增加.
목적 탐토결막송이증발생발전여구결막림파관확장적관계.방법 병례대조연구.상해중의약대학부속보타의원안과문진2012년1월지3월취진적60 ～ 80세환자중,안결막송이증진단표준련속입선100례작위연구대상；채용수궤수자표법추취100례비결막송이증적안과환자작위림상대조조.용렬극등검사법관찰구결막림파관확장정황,채용상간광단층성상(OCT)구결막화근막도상소묘분석,수술절제림파관확장구결막조직병이학검사,병채용림파관특이성표기물D-240대조직진행면역조직화학염색,Envision이보법감정.대각급결막송이증림파관확장발생백분비진행x2검험,대결막송이증등급여구결막림파관확장적수거진행상관성분석.결과 100례(183지안)결막송이증환자중반유구결막림파관확장자29지안,점15.84％；대조조100례(200지안)구결막림파관확장자8지안,점4.00％,량조차이유통계학의의(x2=15.36,P＜0.001).안조결막송이증분급표준:Ⅰ급중구결막림파관확장위8.60％,Ⅱ급중구결막림파관확장위12.96％,Ⅲ급중구결막림파관확장위37.03％,Ⅳ급중구결막림파관확장위44.44％.각급결막송이증림파관확장발생백분비차이유통계학의의(x2 =18.61P＜0.001);결막송이증등급여구결막림파관확장발생유상관성(r =0.271,P＜0.001).OCT소묘림파관확장다위구결막상피하,부분위우구결막고유층,변계청초,낭강내충만액체,유단강혹다낭강,미루급근막.11례조직병이학현시구결막고유층경미적만성염증개변반유대량림파관확장,확장적림파관강내충만분홍색담염적림파액,림파관표기물증실확장적관강위림파관.결론 구결막림파관확장가능시결막송이증발생발전적원인지일,수착결막송이증분급증고,구결막림파관확장발생증가.
Objective To investigate the relationship between the occurrence and development of conjunctivochalasis and bulbar conjunctival lymphangiectasia.Methods Case cortrol study.One hundred cases with conjunctivochalasis treated from January to March 2012 were selected to study,and 100 cases with no conjunctivoch alasis as the control group at the same time.To observe bulbar conjunctiva lymphatic duct dilatation using slit lamp microscope,analysis bulbar conjunctiva and fascia images by OCT scanning,and ablate lymphatic of conjunctival tissue for pathologic examine.Results Twenty-nine eyes of the bulbar conjunctiva lymphangiectasia associated with 100 cases (183 eyes) conjunctivochalasis patients,accounting for 15.84％ ; 8 eyes of the ball conjunctival lymphatic dilation in control group of 100 cases (200 eyes),accounting for 4.00％.The difference between the two groups was statistically significant (x2 =15.36,P ＜0.001).OCT scanning showed that lymphangiectasia of the conjunctiva is at the subcutaneous mainly,some in the conjunctival lamina propria.They are border-clear,full-filled fluid,single-lumen or multi lumens,not involving the fascia.The histopathological examination showed that the lamina propria of the bulbar conjunctiva mildly chronic inflammatory changes accompanied by a large number of lymphangiectasia.Conclusion Bulbar conjunctival lymphangiectasia may be one of the reasons for the conjunctivochalasis.