吴蔷茵　于大仆

[摘要] 目的 探讨曲安奈德泪阜下注射联合翼状胬肉切除术对控制术后复发的疗效。 方法 选择2016年1～11月期间收治26只翼状胬肉眼，常规翼状胬肉切除术后，曲安奈德注射液4 mg行泪阜下注射。观察术后球结膜是否有结膜下翼状胬肉样组织增生及角膜愈合情况、角膜缘新生血管。 结果 术后1～2 d，26只眼均结膜平复、充血减轻、胬肉完全消退；角膜上皮修复、无新生血管、无胬肉增生。随访6～8个月，平均（7±2）个月，其中，26只眼复发1只眼，复发病例为3型。复发病例表现为：内侧结膜充血，结膜下翼状胬肉样组织增生，但侵入角膜小于2 mm。结论 曲安奈德注射液泪阜下注射对控制翼状胬肉术后复发有一定疗效。

[关键词] 翼状胬肉；泪阜；睑裂斑；曲安奈德；新生血管

[中图分类号] R779.6 [文献标识码] B [文章编号] 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

翼状胬肉是眼科的常见病，严重时不仅影响视功能，而且有碍美观，目前无理想控制方法。翼状胬肉是由增殖的球结膜侵袭到角膜上皮的病变组织，呈三角形，如翼状。只限于睑裂部，多见于鼻侧，是纤维结缔组织的变性。鼻侧角膜缘相邻处的球结膜侵袭到角膜上，呈三角形逐渐向角膜中央生长，侵及前弹性层和浅基质层。其尖端称为头，角膜缘处为颈，球结膜上为体。翼状胬肉上有血管水平走行，进行性的翼状胬肉充血尤为显著，组织肥厚，头部前方角膜上有点状浸润。主要治疗方法是手术，但术后复发率高，复发的翼状胬肉，因瘢痕组织增多，睑球粘连，眼球运动障碍，手术更为困难，常需黏膜移植[1]，降低复发率的手术方法一直是翼状胬肉手术研究的重要课题。……