结膜松弛症临床与基础研究  

The basic and clinical study on conjunctivochalasis

作　　者：张兴儒[1] 许琰[1] 李青松[1] 刘晔翔[1] 刘祖国[2] 沈江帆[3] 蔡瑞霞[4] 俞彰[5] 

机构地区：[1]上海中医药大学附属普陀医院眼科,上海200062 [2]中山大学中山眼科中心 [3]上海中医药大学附属普陀医院核医学科,上海200062 [4]上海中医药大学附属普陀医院病理科,上海200062 [5]复旦大学上海医学院电镜室

出　　处：《中国实用眼科杂志》2005年第1期83-87,共5页Chinese Journal of Practical Ophthalmology

基　　金：上海市普陀区卫生科研基金资助项目 (普卫 2 0 0 2 -2 2 )

摘　　要：目的　探讨结膜松弛症发病机制 ,寻求有效治疗方法。方法　用ColoBarTM Schirmer泪液试纸常规检查 ,观察泪河高度及形态、 2 %荧光素滴眼测定泪膜破裂时间、荧光素活体染色、用法国Luneau公司的Cochet&Bonnet敏感度测试仪测量眼表知觉敏感度 ,在SPECT下 ,用99mmTcO-4动态显像比较结膜松弛症与对照组泪液排除功能。观察结膜松弛症组织病理及超微结构改变。比较四种不同的手术疗效。结果　Schirmer试验结膜松弛症组与对照组比较 ,差异无显著意义 ,P >0 0 5。结膜松弛症组泪河、BUT、荧光素活体染色、知觉敏感度异常较对照组多 ,差异有显著意义 (P <0 0 1)。结膜松弛症组T1/2值 (2 92± 198)明显大于对照组 (110± 38) ,差异有显著意义 (t=3 5 8,P <0 0 1)。结膜松弛症组结膜病理组织学表现为结膜上皮增生 ,弹力纤维减少及慢性炎症等病理改变 ,与对照组比较差异有显著意义 (P <0 0 1)。结膜松弛症超微结构改变主要是成纤维细胞功能改变。手术后随访 6月 ,结膜新月形切除术组有效率 87 5 % ,眼轮匝肌移位缩短术组有效率 6 6 6 % ,结膜缝线固定术组有效率 75 0 % ,结膜切除羊膜移植术组有效率 6 0 0 %。结论　结膜松弛症有泪液学改变。病理组织学表现为弹力纤维减少 ,结膜成纤维细胞功能改变 ,手术治?Objective To evaluate the pathogenesis of conjunctivochalasis,then to search effective therapy methods. Methods Compare ocular surface lacrimology changes of conjunctivochalasis with control group in Schirmer test,tear meniscus,tear break up time,fluorescein staining of ocular surface,ocular surface sensation, 99mm Tc-Single-photo Emission Computed Tomography( 99mm Tc-SPECT).To observe the histopathological and ultrastructure changes of conjunctival tissue.Compare the effect of four surgical operation methods. Results The Schirmer test did not show a significant change( P >0 05).There was significant differences in Schirmer test,tear meniscus,tear break up time,fluorescein staining of ocular surface,ocular surface sensation.( P <0 01).T 1/2 of conjunctivochalasis(292±198)was significantly bigger(t=3 58, P <0 01)than T 1/2 of control group(110±38).The pathologic present of conjunctivochalasis,compared with the pathologic present of control group showed significant change( P <0 01),is an evident with conjunctival epithelium proliferation,the decrease of elastic fiber and a chronic inflammation.The main change in ultrastructure of conjunctivochalasis was the fibroblasts′.function.With follow up of six months after surgery,we noted the effect ratio was 87 5% in crescent shaped resection,66 6% in sphincter palpebrarum decurtation and displacement,75 0% in conjunctival fixation to sclera,60 0% in conjunctival resection and amniotic membrane transplantation. Conclusions There were lacrimology changes in conjunctivochalasis.In histopathological,it showed the decrease of elastic fiber and the fumctional change of fibroblasts.It was effective for tearing to resect the redundant conjunctival tissue.

关 键 词：结膜松弛症 对照组 有效率 泪液 功能改变 活体染色 泪河 意义 差异 BUT 

分 类 号：R777.3[医药卫生—眼科] R779[医药卫生—临床医学]