义眼座植入同期利用羊膜移植结膜囊重建术的临床观察  

Clinical effect of amniotic membrane transplantation for reconstruction of conjunctival sac combined with orbital implantation

作　　者：崔红光[1] 陈艳红[1] 郦惠燕[1] 

机构地区：[1]浙江大学医学院附属第一医院浙益眼科中心,杭州310003

出　　处：《中华眼科杂志》2005年第11期1005-1008,共4页Chinese Journal of Ophthalmology

摘　　要：目的探讨结膜囊狭窄患者义眼座植入同期利用羊膜移植重建结膜囊的临床效果。方法对23例结膜囊狭窄患者行义眼座植入同时行结膜囊重建术。术中下穹隆采用埋线法固定在眶下壁骨膜,保存羊膜移植于结膜缺损区,上下睑缘褥式缝合。每周打开眼睑并用荧光素试纸染色,观察结膜上皮生长情况。术后2个月拆除上下眼睑缝线,定制合适的义眼。结果术后第4周20只术眼羊膜表面全部被结膜上皮覆盖,其余3只术眼发生羊膜融解,结膜上皮未愈。术后2个月4只Ⅰ度结膜囊狭窄患眼全部治愈;10只Ⅱ度结膜囊狭窄患眼中8只治愈,2只好转;9只Ⅲ度结膜囊狭窄患眼中3只术眼痊愈、3只术眼好转,余3只术眼无效,其中1只术眼半年后重新行结膜囊成形术。完成治疗的21例患者无义眼座暴露、感染及睑球粘连等并发症,对术后眼座的活动度和外观比较满意。结论对于Ⅰ和Ⅱ度的结膜囊狭窄采用保存羊膜移植同期行眼座植入术是安全可行的。对于Ⅲ度结膜囊狭窄采用保存羊膜移植疗效欠佳。(中华眼科杂志,2005,41:1005-1008)Objective To observe the clinical effect of amniotic membrane transplantation for reconstruction of conjunctival sac combined with orbital implantation. Methods Twenty three cases suffered of conjunctival constriction were treated with amniotic membrane transplantation for reconstruction of conjunctival sac and combined with orbital implantation simultaneously. Buried suture of inferior conjunctival fornix via skin next to the inferior orbital margin was performed. The preserved amniotic membrane was flattened onto the conjunctival defect area and the superior and lower eyelid were closed with mattress suture. The eyelids were opened and stained with fluorescein test paper every week in order to observe the growth of conjunctival epithelium. Stitches were removed two months after surgery and the suitable prosthesis was made. Results Conjunctival epithelium migrated to the surface of the amniotic membrane and covered it completely in 20 cases four weeks after surgery. Amniotic membrane was dissolved and conjunctival epithelium could not cover the defect areas in the rest 3 cases. Two months after surgery, 4 eyes of degree Ⅰ conjunctival sac constriction were all cured. In degree Ⅱ conjunctival sac constriction, 8 eyes were cured and 2 eyes were improved. In degree Ⅲ conjunctival sac constriction, 3 eyes were cured, 3 eyes improved, and 3 eyes failed. Among the failed eyes, one eye was underwent reconstruction of conjunctival sac again in six months. No exposure, secondary infection or symblepharon were occurred in 21 eyes with completed treatment, and these patients were satisfied with the good motility and the cosmetic results. Conclusion Preserved amniotic membrane transplantation for reconstruction of conjunctival sac combined with orbital implantation is safe and effective in degree Ⅰ and degree Ⅱ conjunctival sac constriction, but less than perfect in degree Ⅲ conjunctival sac constriction.

关 键 词：眼眶植入物 羊膜 移植 结膜疾病 

分 类 号：R779.6[医药卫生—眼科]