眼座植入术后结膜切口延迟愈合的原因分析  

Delayed conjunctival healing after hydroxyapatite sphere implantation

作　　者：孙英[1] 范先群[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院眼科,200011

出　　处：《临床眼科杂志》2015年第6期545-547,共3页Journal of Clinical Ophthalmology

摘　　要：目的分析一期或二期义眼座植入术后发生结膜切口延迟愈合的原因及对策。方法 2003至2012年期间眼座植入术后出现结膜延迟愈合患者8例（8只眼）,手术方式及术后处理均按眼科常规处理。结果术后2~4周随访时发现患眼出现结膜切口愈合不佳,眼座无暴露。取出薄壳,局部点用氧氟沙星、贝复舒滴眼液后最快2周,最迟将近2个月后愈合,其中有1只眼合并剪除疝出的筋膜组织后重新缝合结膜切口、另有2只眼拆除缝线后2周愈合。8只眼愈合后均可配戴义眼片。结论结膜切口愈合不良的原因可能如下：局部血供差、缝线因素、结膜瘢痕、张力及手术操作等因素,加强术前患者全身及眼局部情况的评估,可以减少术后并发症的发生;伤口延迟愈合发生后,注意改善血供、调整切口缝合张力、减少局部缝线刺激、适当的外力适度牵拉扩张结膜囊、局部应用促生长因子等可缩短愈合进程,促进伤口愈合。Objective To observe and discuss the causes and treatments of delayed conjunctival healing after hydroxyapatite（ HA） sphere implantation. Methods Eight patients diagnosed with delayed conjunctival healing after HA sphere implantation between 2003 and 2012 were enrolled in this study. All patients received standard surgical procedures and postoperative managements. Results Conjunctival rupture began to be noticed at 2 ~ 4 weeks after the surgery.Though,there was no HA sphere exposure. Conjunctival cut healed within 2 weeks to 2 months after the shield was taken out and antibiotics and b FGF eye drops were administered. In one case Tenon＇s membrane herniated through the conjunctival wound. Herniated tissue was removed and wound was re-closed. In 2 other cases conjunctival wound healed 2 weeks later after the suture was removed. All the patients could tolerate the prosthesis at 2 months. Conclusion The causes of delayed conjunctival healing included poor local blood supply,suture factors,conjunctival scars,and operational factors.Careful evaluation before the surgery would reduce these complications. Once the wound healing is delayed,management should be directed to improve local blood supply,reduce conjunctival tension,and tropical use of b FGF.

关 键 词：结膜切口延迟愈合 眼座植入术后 

分 类 号：R779.6[医药卫生—眼科]