硬腭黏膜移植联合眶周皮瓣转移重建眼睑的眼表功能  

Ocular surface function of combination of hard palate mucosal grafts with orbicularis musculocutaneous flap for eyelids re-construction in patients

作　　者：刘桂琴[1] 周凤[1] 欧阳明[1] 李钫[1] 林华[1] 

机构地区：[1]暨南大学第二临床学院深圳眼科医院,518001

出　　处：《眼科》2008年第3期178-181,共4页Ophthalmology in China

摘　　要：目的评价硬腭黏膜移植联合眶周皮瓣转移治疗因机械伤、眼睑恶性肿瘤切除术后眼睑全层缺损的疗效,设计回顾性病例系列。研究对象13例(13眼)因机械伤或眼睑恶性肿瘤切除术后眼睑全层缺损患者:方法对13例患者行白体硬腭黏膜移植联合眶周皮瓣转移术。记录手术前、后患者的睑裂长度、睑裂高度、睑闭合不全的程度,泪膜破裂时间,SchirmerⅠ试验和角膜荧光素染色积分,术后半年睑缘切开时取移植的硬腭黏膜进行组织学检查。随访8个月以上:主要指标手术效果、泪膜破裂时间、SchirmerⅠ试验和角膜荧光素染色积分、移植后硬腭黏膜的组织学结构。结果11眼达到眼表功能优秀的治疗效果,2眼良好,手术前后患者的眼表功能无明显变化。自体硬腭黏膜移植眼睑后可与残留睑板结膜良好愈合,未见有植人物感染现象:手术半年后硬腭黏膜上皮与结膜上皮结构类似,黏膜上皮内出现杯状样细胞。结论硬腭黏膜片移植联合眶周皮瓣转移是眼睑重建的良好方法,手术不影响患者的眼表功能。受眼局部微环境的影响,硬腭黏膜可能逐渐向结膜形态发生转变。Objective To evaluate the effect of combination of hard palate mucosal grafts with orbicularis musculocutaneous flap for eyelids reconstruction in patients with complete eyelid defect caused by mechanical damage or malignant tumor of eyelid. Design Retrospetive case series. Participants Thirteen patients （13 eyes） with complete eyelid defect. Methods Autologous hard palate mueosal grafts combined with orbicularis museulocutaneous flap were applied for eyelid reconstruction. Before and after operation, palpebral fissure lengthes, palpebral fissure heights, lagophthalmos, tear film breakup time, Schirmer I test, corneal fluorescein staining were measured in all patients. The histology of transplanted hard palate mucosa were observed in half a year of operation. The follow-up time was over 8 months. Main Outcome Measures The outcomes of operation, tear film breakup time, Schirmer I test, corneal fluorescein staining and histology of transplanted palate mucosa. Results The outcomes of operation were excellent in 11 eyes, good in 2 eyes. There wase not significantly different in the function of ocular pre and post operation. Autologous hard palate mucosa healed up well with residual tarsus and eonjunctiva. No implants shedding or infection happened postoperatively. The structure of epithelium of hard palate mucosa resembled epithelium of eonjunctiva in half a year of operation. There were goblet-like cells in the palate mucosa. Conclusion The combination of hard palate mucosal grafts and orbicularis musculocutaneous flap supplies a good method for reconstruction of eyelid and ocular surface function; Transplanted palate mueosa may gradually change towards the structure of eonjunetiva epithelium under the influence of ocular microenviroment.

关 键 词：硬腭黏膜 眼睑缺损 眼表功能 临床分析 

分 类 号：R739.7[医药卫生—肿瘤]