羊膜和唇黏膜联合自体角膜缘移植重建眼表热化学烧伤后结膜穹窿的疗效观察  

Fornix reconstruction with oral mucosal graft,conjunctival autograft and amniotic membrane transplantation after chemical and thermal burns on ocular surface

作　　者：李瑾[1] 林明[1] 傅瑶[1] 陆雯娟[1] 邵春益[1] 范先群[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院眼科,上海200011

出　　处：《上海交通大学学报（医学版）》2011年第8期1061-1064,1072,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市重点学科建设资助项目(S30205);上海市科委重点课题资助项目(04JC14041);上海市科委自然科学基金(11ZR1420000);上海市卫生局面上项目(2010242)~~

摘　　要：目的观察羊膜和唇黏膜联合自体角膜缘移植矫正眼表热化学烧伤后睑球粘连和重建结膜穹窿的临床疗效。方法收集17例(18眼)眼表热化学烧伤后睑球粘连病例的临床资料,其中Ⅱ度烧伤2眼,Ⅲ度烧伤14眼,Ⅳ度烧伤2眼;所有病例均在分离睑球粘连后,采用唇黏膜移植修复睑结膜和球结膜缺损;做1~3对穹窿加深固定唇黏膜植片,利用健眼或患眼未损伤区的自体角膜缘移植修复角膜缘损伤,以新鲜羊膜覆盖整个角膜至穹窿,上下睑缘临时缝合,术后加压包扎1周限制眼睑活动。回顾患者术后情况和随访资料,分析疗效(成功、部分成功和失败),统计手术成功率。结果术后随访时间为12~24个月(中位随访时间为15.24个月)。17例患者中,完全成功12例,结膜穹窿解剖深度与对侧健眼对称,无粘连和瘢痕形成,眼球活动自如;部分成功3例,术后局部瘢痕增生,重建结膜穹窿略狭窄,解剖深度达到正常深度的2/3以上;手术成功率为88.24%;失败2例,术后睑球粘连复发,穹窿消失。结论羊膜和唇黏膜联合自体角膜缘移植能有效矫正眼表热化学烧伤后睑球粘连,重建稳定结膜穹窿。Objective To observe the outcomes of symblepharon relief and fornix reconstruction with oral mucosal graft,conjunctival autograft and amniotic membrane transplantation after chemical and thermal burns on ocular surface. MethodsThe clinical data of 17 patients(18 eyes) with symblepharon after chemical and thermal burns on ocular surface were collected.There were 2 eyes with burn of degree Ⅱ,14 eyes with burn of degree Ⅲ,and 2 eyes with burn of degree Ⅳ.After relief of symblepharon,palpebral conjunctiva and bulbar conjunctiva defects were reconstructed by oral mucosal graft.Limbal autograft was conducted to restore limbal injury,and amniotic membrane transplantation was performed to cover the cornea till fornix.Palpebral movement was restricted within one week after surgery.The conditions after surgery and follow-up data were reviewed,the outcomes(overall success,partial success and failure) were analysed,and the success rate of surgery was calculated. Results Patients were followed up for 12 to 24 months(median,15.24 months).Overall success was achieved in 12 patients,with the same depth of fornix as the healthy eye,no adhesion and scar,and unlimited eyeball movement.Partial success was achieved in 3 patients,with regional scar hyperplasia,slightly narrow fornix,and depth of fornix over 2/3 of normal one.The success rate of surgery was 88.24%.Failure occurred in 2 patients,with recurrence of symblepharon,and disappearance of fornix. Conclusion Favorable outcome can be achieved with oral mucosal graft,conjunctival autograft and amniotic membrane transplantation in relief of symblepharon and reconstruction of fornix after chemical and thermal burns on ocular surface.

关 键 词：穹窿重建 唇黏膜移植 角膜缘移植 羊膜移植 热化学烧伤 眼表 

分 类 号：R779.6[医药卫生—眼科]