双层羊膜移植联合自体结膜移位术治疗睑球粘连  

Effect of double amniotic membrane transplantation combined conjunctiva shift in patients with symblepharon

作　　者：刘琳[1] 李燕[2] 张波[2] 

机构地区：[1]广州军区广州总医院眼科,广州510010 [2]中山大学中山眼科中心眼科,广州510060

出　　处：《广东医学》2011年第8期996-998,共3页Guangdong Medical Journal

基　　金：广东省医学科研基金资助项目(编号:B2006118);广州市科技领域专项创新药物课题(编号:2006Z3-E4091)

摘　　要：目的观察和研究双层人新鲜羊膜移植联合自体结膜移位术治疗各种原因引起的睑球粘连的临床效果。方法睑球粘连患者共42例(45眼),其中Ⅰ级14眼,Ⅱ级13眼,Ⅲ级9眼,Ⅳ级9眼。入院后行粘连部位分离及机化瘢痕组织切除,纤维蛋白生物黏合剂及连续锁边缝合固定双层人新鲜羊膜,并用移位的结膜来补充部分巩膜暴露区,以重新形成正常的结膜囊。术后随访6～7个月,包括观察局部反应、结膜上皮的生长情况、羊膜的黏附情况等。结果 45眼术后无一感染,其中32眼(71.1%)手术成功;10眼(22.2%)手术部分成功;3眼(6.7%)手术失败,结膜囊变浅,瘢痕增生粘连。结论双层新鲜人羊膜黏附式及连续交锁缝合能提供平坦光滑的植床,可促进残存的结膜上皮增殖分化,重建结膜表面。同时缺区周围结膜的分离和移位缩小了巩膜暴露区,更有利于在羊膜溶解之前完成结膜上皮化的过程,故此方法可明显提高睑球粘连的治愈率,且降低术后复发率,效果满意。Objective To investigate the therapeutic efficacy of double amniotie membrane transplantation combined conjunetiva shift in treating symblepharon. Methods 42 patients （45 eyes） with symblepharon, in which there were 14, 13, 9 and 9 eyes with first, second, third and fourth degree, in general hospital of Guangzhou Military Command were enrolled. Syneehiolysis combined double amniotic membrane grafting was performed in all subjects. The double amniotic membrane was fixed to the ocular surface using fibrin tissue adhesive and continuous lock stitch suture. At the same time, conjunctiva was shifted to the sclera exposure area from surrounding. Local reactions, healing of the epithelial defects, and amniotic membrane adhesion were assessed in the follow - up of 6 to 7 months. Results No infection was found in all cases. Complete and partial recovery was reported in 32 （71.1% ） and 10 （22. 2% ） eyes, respectively. However, surgery failed in 3 eyes （6.7%）, presenting with conjunctiva scar formation or conjunctival sac shallow. Conclusion Amniotic membrane transplantation with continuous lock stitch suture and fibrin tissue adhesive offers an smooth surface facilitating proliferation of remained partial healthy conjunctival epithelium. Conjunctiva shifted from surrounding smaller reduces the sclear exposure area. These improve the efficacy of surgery and reduce relapse.

关 键 词：连续交锁缝合 组织粘合剂 双层羊膜 结膜移位 睑球粘连 

分 类 号：R779.6[医药卫生—眼科]