目的:分析羊膜移植与结膜瓣遮盖在角膜溃疡治疗中的临床疗效,探讨其在角膜溃疡治疗中的不同手术适应范围,为临床治疗提供循证医学依据。方法:回顾性分析我院2004-10/2009-07行羊膜移植或结膜瓣遮盖手术治疗的角膜溃疡住院患者46例47眼,其中病毒性角膜溃疡13例14眼,真菌性角膜溃疡19例19眼,细菌性角膜溃疡7例7眼,蚕食及边缘性角膜溃疡3例3眼,无菌炎症性角膜溃疡2例2眼,手术引起角膜内皮失代偿致角膜上皮大泡、溃疡2例2眼;穿孔9例9眼。上述患者行病灶清除+羊膜移植或结膜瓣遮盖手术治疗,行羊膜移植17例18眼,结膜瓣遮盖29例29眼,其中结膜瓣遮盖后行角膜移植2例2眼,术后针对原发病进一步进行药物治疗。结果:羊膜移植治疗后,治愈13例14眼,治愈率为78%(14/18);行结膜瓣遮盖治疗后,治愈23例23眼,治愈率为79%(23/29);二者在临床治愈率上没有明显的差别(P>0.05)。结论:羊膜移植与结膜瓣遮盖根据不同的溃疡类型及不同的溃疡发展进程选择合适的手术方式可以达到较好的手术疗效。

AIM:To provide evidence for Evidence-Based Medicine on clinical treatment of corneal ulcers by analyzing the clinical efficacy between amniotic membrane transplantation and conjunctival flap covering surgery,in addition,to explore the different surgical adaptabilities for each treatment of corneal ulcers.·METHODS:This retrospective review comprised 46 cases of hospitalized corneal ulcers patients (47eyes) who had amniotic membrane transplantation or conjunctival flap covering surgery from October 2004 to July 2009,including 13 cases 14 eyes with viral corneal ulcer,19 cases 19 eyes with fungal corneal ulcer,7 cases 7 eyes with bacterial corneal ulcer,3 cases 3 eyes with erosion and marginal corneal ulcer,2 cases 2 eyes with sterile inflammatory corneal ulcer,2 cases 2 eyes with corneal epithelial bullae and ulcers for corneal endothelial decompensation caused by optical surgery,9 cases 9 eyes with perforation.All the patients were treated with removal of the necrotic corneal tissue combined with amniotic membrane transplantation or conjunctival flap covering surgery and then were treated with drugs based on primary disease.·RESULTS:We found 17 cases 18 eyes treated with amniotic membrane transplantation,29 cases 29 eyes treated with conjunctival flap covering surgery in which 2 cases 2 eyes had corneal transplantation there after.13 cases 14 eyes treated with amniotic membrane transplantation were cured,the cure rate was 78% (14/18);23 cases 23 eyes treated with conjunctival flap covering surgery were cured,the cure rate was 79% (23/29);the clinical cure rates between them were of no significant difference(P>0.05).·CONCLUSION:Amniotic membrane transplantation and conjunctival flap covering surgery in the treatment of corneal ulcers can achieve better surgical treatment if appropriate surgical method is selected according to different types and different ulcer process.

R779.6