改良结膜瓣遮盖术治疗穿孔或近穿孔感染性角膜溃疡的探讨  

The study of the treatment of Modified conjunctival flap microsurgery to the cornea infective ulcer with perforation or nearly perforation

作　　者：吴洁[1] 龙潭[1] 朱海峰[1] 马挺[1] 杜蕊[1] 程燕[1] 梁厚成[1] 

机构地区：[1]西安市眼科医院,陕西省眼科研究所,西安市第一医院,西安710002

出　　处：《中国实用眼科杂志》2008年第5期484-487,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨应用改良结膜瓣遮盖术治疗感染基本控制的穿孔或近穿孔的感染性角膜溃疡。方法选择感染基本控制的角膜溃疡穿孔12例、近穿孔病例52例（共64只眼）。手术中溃疡面修剪清创，4％碘酊烧灼溃疡面或边缘（穿孔者），在临近角膜溃疡处转移球结膜瓣，将Tenon囊组织单层或多层于创面修剪后间断固定缝合，再将已转移的球结膜瓣遮盖于表面间断固定缝合。结果47只角膜溃疡近穿孔患眼于术后一次成功，术后2w内余5只眼结膜瓣溶解脱落（3例再次结膜瓣手术成功，2例放弃治疗）手术一次成功率92．19％。角膜溃疡穿孔患眼术后成功率达100％，但是有3只眼术后发生继发性青光眼。结论改良结膜瓣遮盖手术在角膜溃疡感染基本控制即可进行，操作简单，便于基层开展，尤其是在无角膜材料、无条件进行角膜移植者可缩短疗程，保存眼球，为下一步复明手术打下基础。Objective To investigate the treatment of the modified conjunctival flap microsurgery （m-CFM） to the cornea infective ulcer with perforation or nearly perforation. Methods The m-CFMs were operated to the 12 patients with perforated cornea ulcer and 52 ones with nearly perforated ulcer. Before surgeries, it should be done as possible as we could to control the infection. Then while surgery, the ulcers were cleared, and the conjunctival flap and the Termon＇s capsule were sew on the cornea to envelope the ulcer in file. Results Among the patients with nearly perforation, the infections in 47 eyes were controlled by one surgery, as the same time, the flaps on other 5 eyes were dissolved in 2 weeks （the second surgeries were done to the 3 eyes of them, and succeeded, and the other 2 were abandoned）, the surgeries to 12 eyes with perforation were all succeed, though 3 of them catch a secondary glaucoma. Conclusions The m-CFM could be done when the infection of the cornea ulcer was be controlled, and that is so easy to operate that it could be done at the elementary hospital, especially could be done to shorten the cure circle and to protect the eyes when the cornea transplantation couldn＇t be done.

关 键 词：角膜溃疡 结膜瓣遮盖术 穿孔 治疗方法 

分 类 号：R772.210.5[医药卫生—眼科] R779.6[医药卫生—临床医学]