摘要
目的评价翼状胬肉切除联合应用丝裂霉素C(MMC)与自体结膜移植对手术复发率的影响。方法系统检索Medline,Embase,Cochrane图书馆,中国生物医学文献数据库以及OpenSIGLE和NTIS数据库中有关MMC和自体结膜移植治疗翼状胬肉的临床对照试验。由研究人员根据Cochrane偏倚评价和GRADE系统推荐分级方法,对证据质量进行严格评价和资料提取,对符合质量标准的文献进行Meta分析。结果共纳入了13篇文献。对于原发性翼状胬肉术中联合使用MMC的手术复发率较联合自体结膜移植的高(OR=2.38,95%可信区间为1.45～3.91,I2=29%),裸露巩膜并术后使用MMC与自体结膜移植的复发率无显著性差异(OR=0.66,95%可信区间为0.30～1.42,I2=0%),术中联合使用MMC和自体结膜移植的复发率与单纯使用自体结膜移植无显著性差异(OR=0.41,95%可信区间为0.16～1.01,I2=16%)。在其他涉及的并发症中,表浅角膜炎,巩膜变薄、缺血、坏死,刺激症状和持续性上皮缺损,在使用MMC中要高于自体结膜移植。结论对于原发性翼状胬肉,自体结膜移植的复发率低于术中使用MMC,且其他严重的并发症发生率亦较低。但是对于有青光眼病史或青光眼家族史的患者尽量避免使用自体结膜移植。
Objective To evaluate the effect of the mitomycln C （MMC） and conjanctiva autograft （ CA ） in the recurrence of the pteryginm. Methods We searched the randomised trials of petlents with pteryginm who received MMC or/and CA while the surgery in Medline, Emhase, the Cochrane library, CBMdise, OpenSIGLE and NTIS. Data were extrected on the relevant methodological domains to minimize the bias in the analysis with use of the Cochrane methods for hi- as assessment and Grading of Recommendations Assessments Development and Evaluation （GRADE） methods. Results 13 studies met the inclusion criteria. The recurrence rate of pterygium with intraoperafive MMC was higher than that with CA （OR =2.38,95% confidence interval 1.45 -3.91,12 =29% ）. The postoperative MMC shared the rate with the CA （ OR = 0. 66,95% confidence interval 0.30 - 1.42, 12 = 0% ）, and the intraoperative MMC combined with CA did with the CA alone （ OR =0.41,95% confidence interval 0. 16 - 1.01, 12 = 16% ）. At the same time the rate of some other complications such as keratitis, sclem attenuation, irritating, persistent epithelium defect, with MMC were higher than with CA. Conclusion The recurrence rate of pterygium with MMC is higher than with CA, and the other main complications with the latter are also lowered. But the surgery methods should he considered when the patient has the history or family history of glaucoma.
出处
《临床眼科杂志》
2012年第5期394-398,共5页
Journal of Clinical Ophthalmology
