目的：探讨胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉的远期效果。

方法：2003年12月－2008年12月在我院就诊的原发性翼状胬肉患者55例57眼，均采用胬肉切除联合自体角膜缘干细胞移植治疗，术后随访2～8年，平均5.3年。观察创面愈合情况、治疗效果和并发症情况。

结果：术后早期患者均有不同程度的充血、水肿和异物感，3～5d 后症状逐渐减轻，一周左右完全消失。角膜创面完全上皮化时间为4～7d，平均4.83d。术后有持续性眼表刺激症状者7例，术后残留纤维组织者1例，角膜浅层瘢痕者4例。术后随访2～8年，平均5.3年，复发8例8眼 (复发率13.11％)。术后1年时复查OSDI 评分，所有患者较术前评分均有不同程度的降低，与术前相比，两组评分和构成比差异有统计学意义(P＜0.05)。术后5年时复查OSDI评分较1年前稍有降低，但差异没有统计学意义(P＞0.05)。术后1、5年时泪液基础分泌[(12.95±4.03) mm，(12.68±4.77) mm]和泪膜破裂时间 [(10.55±4.13)s, (10.03±4.64) s] 较术前[(9.48±3.34)mm，(8.14±3.57)s] 明显改善，差异有统计学意义(P＜0.05)。

结论：应用胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉，术后早期症状轻、消失快，远期复发少，效果良好。

Purpose: To evaluate the long-term efficacy of pterygium excision combined with autologous corneal limbal stem cell transplantation in the treatment of pterygium．

Methods: Fifty five patients (57 eyes) diagnosed with primary pterygium undergoing pterygium excision combined with autologous corneal limbal stem cell transplantation between December 2003 and December 2008 were enrolled in this study. Postoperative follow-up endured for 2-8 years, 5.3 years on average. The wound healing, clinical efficacy and postoperative complications were observed．

Results: During early stage after surgery, all patients presented with varying degree of hyperemia, edema and sense of foreign body, which were gradually mitigated 3-5 d later and completely recovered in approximately 1 week. The corneal wound was completely epithelized within 4-7 d, 4.83 d on average. Seven patients had persistent ocular surface irritation symptoms after surgery, one case had residual fibrous tissues and four patients developed superficial corneal scars. Postoperative follow-up endured for 2-8 years, 5.3 years on average. Eight patients (8 eyes) recurred with a recurrence rate of 13.11％. In all patients,  postoperative OSDI score was significantly decreased at 1-year reexamination. OSDI score and constitution ratio significantly differed between two groups (both P＜0.05)．At postoperative 5 years, OSDI score was slightly lower compared with that in last year with no statistical significance(P＞0.05)．At post operative 1- and 5-year, basic tear secretion was (12.95 ±4.03) mm and (12.68 ±4.77) mm, tear film break-up time was (10.55±4.13)s and (10.03±4.64)s. Both indexes were significantly improved compared with (9.48±3.34) mm and (8.14±3.57)s before surgery (all P＜0.05)．

Conclusion: Pterygium excision combined with autologous corneal limbal stem cell transplantation is an efficacious treatment of pterygium with mild postoperative symptoms, rapid recovery, low long-term recurrence rate and high efficacy． 

目的：比较翼状胬肉两种不同手术方式后巩膜溶解的发生概率，探讨产生巩膜溶解的原因，选择合理手术方式。方法：对本院两年来263例翼状胬肉采用两种不同的手术方式，观察术后发生巩膜溶解的情况，并通过局部药物进行治疗。结果：263例翼状胬肉患者，130例采用胬肉切除+结膜瓣转位术，裸露角膜缘3 mm巩膜，术后局部滴0.02%丝裂霉素C(mitomycin C, MMC)，胬肉复发26 例，发生巩膜溶解6例；133例采用胬肉切除+角膜缘干细胞移植术，术后滴0.02% MMC，胬肉复发5例，无1例发生巩膜溶解。结论：翼状胬肉术后发生巩膜溶解，是一种严重的手术并发症，可能与术中过度烧灼巩膜面，巩膜板层暴露于MMC有关。采用胬肉切除+角膜缘干细胞移植术，植片覆盖裸露巩膜，促进巩膜表层愈合，术后避免MMC直接浸润巩膜板层故未见此并发症发生。与传统手术方式相比，复发率低，并发症少，是一种安全、有效的翼状胬肉手术方式。

Objective: To compare the occurrence probability of posterior scleral dissolution in two different surgical methods, and to explore the reasons for the dissolution of the scleral. Methods: Using two different surgical methods on 263 cases of pterygium submitted in our hospital in 2 years, observed the occurrence of scleral at postoperative, and treated with topical drugs. Results: Two hundred and sixty three cases of patients with pterygium, 130 cases of pterygium resection and conjunctival flap transposition, bare 3 mm limbus sclera, postoperative topical mitomycin C (MMC). The recurrence of pterygium in 26 cases, scleral melting in 6 cases; 133 cases of pterygium excision and limbal stem cell transplantation, MMC (0.02% MMC drip after operation, 5 cases of recurrent pterygium, no scleral melting occurred in 1 case. Conclusion: The scleral dissolution occurred after pterygium surgery is a serious complication, which may be related to the excessive burning of the scleral surface, and the lamellar exposure to MMC. Excision of pterygium and corneal limbal stem cell transplantation  were used to cover the exposed scleral, promote the surface healing of the wound, and avoid the MMC direct infiltration of the lamina. Compared with the traditional operation mode, the recurrence rate is low, and the complication is little. It is a safe and effective surgical method. 

原发性翼状胬肉是一种上皮下生长的非肿瘤性变性组织，其发病机制主要与紫外线照射有关，然而，原发性翼状胬肉的具体发病机制仍不明确。近年来，随着医学研究的不断深入，研究显示原发性翼状胬肉的发生发展与多种因素息息相关。病毒感染、氧化应激、炎症反应，抑癌基因失活、DNA 甲基化等因素已被证实与翼状胬肉发病机制有关。此外，凋亡和增殖蛋白的失衡、细胞外基质调节剂和上皮-间充质细胞转化等因素也都在原发性翼状胬肉的发病过程中扮演着重要的角色。这些均可能导致细胞生长和分裂的异常，进而诱发翼状胬肉的形成。然而，各个因素之间的相互作用以及它们在发病过程中的具体作用机制仍有待进一步研究。该文中笔者就当前原发性翼状胬肉的发病机制进行评述，深入探究原发性翼状胬肉的发病机制及不同相关因素在原发性翼状胬肉发病过程中的相互作用。了解不同因素在发病过程中的作用，可以为临床提供更加精准、有效的预防和治疗策略提供依据，为患者带来更好的治疗效果和更高生活质量。

Primary pterygium is a non-neoplastic degenerative tissue that grows subepithelially, and its pathogenesis is mainly related to ultraviolet exposure, however, the full mechanism of primary pterygium remains unclear. In recent years, with the development of medical research, it is found that the occurrence and development of primary pterygium are closely related to a variety of factors. Viral infection, oxidative stress, inflammatory response, inactivation of tumor suppressor genes, DNA methylation and other factors have been shown to be involved in the pathogenesis of pterygium. In addition, imbalances of apoptosis and proliferative proteins, extracellular matrix regulators, and epithelial-mesenchymal cell transformation also play important roles in the pathogenesis of primary pterygium. These can lead to abnormal cell growth and division, which in turn induces the formation of pterygium. However, the interaction between these factors and their specific mechanisms of action in the pathogenesis process still need to be further studied. In this article it reviews the current pathogenesis of primary pterygium, and deeply explores the pathogenesis of primary pterygium and the interaction of different related factors in the pathogenesis of primary pterygium. By understanding the role of different factors in the pathogenesis process, we can provide more precise and effective prevention and treatment strategies for clinical practice, and better treatment outcomes and quality of life for patients.

目的：探讨血管生成拟态(vasculogenic mimicry，VM)与翼状胬肉初发型及复发型的相关性。方法：采用血小板-内皮细胞黏附分子/过碘酸雪夫(platelet endothelial cell adhesion molecule-1/periodic acid-schiff，CD31/PAS)免疫组织化学双重染色法检测139例翼状胬肉组织(初发型105例；复发型34例)和10例正常结膜中VM的表达，分析VM与初发型及复发型翼状胬肉的相关性及其与患者性别、年龄等因素的关系。原代培养人翼状胬肉成纤维细胞(human pterygium fibroblasts，HPFs)，免疫细胞化学染色法鉴定，利用三维培养及PAS染色观察初发型和复发型HPFs构成VM管腔个数的差异。结果：10例正常结膜均未见VM结构，初发型翼状胬肉VM阳性率43.81%，复发型翼状胬肉VM阳性率82.35%，差异具有统计学意义(P<0.001)。相关性分析显示VM与复发型翼状胬肉呈显著正相关(r=0.332)。不同性别、年龄及病程的翼状胬肉患者VM的表达差异均无统计学意义(均P>0.05)。原代培养的HPFs Vimentin表达阳性，符合成纤维细胞特性。细胞三维培养及PAS染色结果提示HPFs具有构建体外VM模型的能力，且复发型HPFs构成的VM管腔数明显高于初发型，差异具有统计学意义(P<0.01)。结论：翼状胬肉组织中存在VM结构，可作为其血供途径之一。VM与翼状胬肉的复发具有密切关系。

Objective: The purpose of this study was to investigate the correlation of vasculogenic mimicry in the primary and recurrent pterygium. Methods: Platelet endothelial cell adhesion molecule-1/periodic acid-schiff (CD31/PAS)immunohistochemical double staining method was adopted to detect the expression of VM in 139 cases of pterygium (105 cases of primary pterygium and 34 cases of recurrent pterygium)and 10 cases of normal conjunctival tissues. The correlation between VM and primary pterygium, recurrent pterygium and the factors such as gender and age of patients were analyzed. Human pterygium fibroblasts (HPFs) were primary cultured and identified by immunocytochemical staining. The differences in the number of VM channels between primary HPFs and recurrent HPFs were observed by three-dimensional culture and PAS staining. Results: There was no VM structure in 10 normal conjunctiva and the positive rate of VM was 43.81% in primary pterygium and 82.35% in recurrent pterygium with a significantly difference (P<0.001). Correlation analysis showed a significant positive correlation between VM and recurrent pterygium (r=0.332). There was no significant difference in the expression of VM in pterygium patients with different sex, age and course (all P>0.05). Vimentin was positive in the primary cultured cells, which was consistent with the characteristics of fibroblasts. The results of three-dimensional culture and PAS staining indicated that HPFs had the ability to construct VM model in vitro, and the number of VM channels constituted by recurrent HPFs was significantly higher than that by primary HPFs, the difference was statistically significant (P<0.01). Conclusion: VM exists in pterygium tissues, and it can be used as one of the blood supply routes, which is closely related to the recurrence of pterygium.

目的：探讨连续锁边缝合联合角膜绷带镜在翼状胬肉手术中应用的效果。方法：采用前瞻性随机对照临床研究。选取2018年1月到2021年6月期间在我院行翼状胬肉切除联合自体角膜缘结膜瓣移植术的患者132例180眼，按结膜瓣固定方式随机分为A、B两组，其中A组患者(64例90眼)行间断缝合固定法，B组患者(68例90眼)行连续锁边缝合法，术毕两组患者均给与配戴角膜绷带镜。比较两组患者的术后眼部疼痛程度评分、术后效果及并发症。结果：术后1、3 d，B组疼痛评分明显低于A组，差异有统计学意义(P<0.01)；术后1、3、7 d两组间角膜染色评分差异无统计学意义(P>0.05)；术前、术后3个月两组间泪膜破裂时间(breakup time of tear film，BUT)差异无统计学意义(P>0.05)，但术后3个月组内的BUT较手术前有明显改善(P<0.05)。术前、术后2周两组间视力差异均无统计学意义(P>0.05)，术后2周两组组内视力较手术前均有明显改善(P<0.05)。随访3个月，两组患者主要术后并发症包括胬肉撕除后浅层基质损伤延迟愈合、线结处结膜增生、结膜植片松脱等，并发症发生率两组相当。结论：采用连续锁边缝合联合配戴角膜绷带镜治疗翼状胬肉可以促进角膜创面的修复，减轻患者的术后刺激症状，提高患者术后舒适度；连续锁边缝合时需要适当增加缝线跨度，可减少术后结膜植片的松脱。

Objective: To investigate the effect of continuous locking suture combined with corneal bandage lens in the operation of pterygium. Methods: A prospective randomized controlled clinical trial was conducted. From January 2018 to June 2021, 132 patients (180 eyes) who underwent pterygium excision combined with autologous limbal conjunctival flap transplantation were randomly divided into group A and group B according to the fixation of conjunctival fla. The patients in group A (64 cases, 90 eyes) were treated with intermittent suture and fixation, and the patients in group B (68 cases, 90 eyes) were treated with continuous locking suture. Both groups were given corneal bandage lenses at the end of the operation. The postoperative ocular pain score, postoperative effect and complications were compared between the two groups. Results: The pain score in group B was significantly lower than that in group A at 1 and 3 d after operation (P<0.01), and there was no significant difference in corneal staining score between the two groups at 1, 3 and 7 d after operation (P>0.05). There was no significant difference in breakup time of tear film (BUT) between the two groups before and 3 months after operation (P>0.05), but the BUT at 3 months after operation in the group was significantly better than that before operation (P<0.05). There was no significant difference in visual acuity between the two groups before and 2 weeks after operation (P>0.05). The visual acuity of the two groups was significantly improved 2 weeks after operation (P<0.05). During the follow-up of 3 months, the main postoperative complications of the two groups included delayed healing of superficial matrix injury after pterygium avulsion, conjunctival hyperplasia, conjunctival graft loosening and so on. Conclusion: Continuous locking suture combined with corneal bandage lens in the treatment of pterygium can promote the repair of corneal wound, reduce the postoperative irritation symptoms and improve the postoperative comfort of patients. It is necessary to increase the suture span during continuous locking suture, which can reduce the loosening of conjunctival graft after operation.