血管化自体下颌下腺移植治疗重症干眼20年研究  

A 20-year study on microvascular autologous transplantation of submandibular gland for treatment of severe dry eye

作　　者：俞光岩[1] 吴立玲[2,3] 蔡志刚[1] 吕岚[4] 丛馨[2,3] YU Guang-yan;WU Li-ling;CAI Zhi-gang;LV Lan;CONG Xin(Department of Oral and Maxillofacial Surgery;Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology ＆ National Engineering Laboratory for Digital and Material Technology of Stomatology ＆ Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China;Department of Physiology and Pathophysiology, Peking Uni-versity School of Basic Medical Sciences, Beijing 100191, China;Department of Ophthalmology, Beijing Tongren Hos-pital, Capital Medical University, Beijing 100069, China)

机构地区：[1]北京大学口腔医学院·口腔医院口腔颌面外科,北京100081 [2]北京大学口腔医学院·口腔医院唾液腺疾病研究中心、口腔数字化医疗技术和材料国家工程实验室、口腔数字医学北京市重点实验室,北京100081 [3]北京大学基础医学院生理学与病理生理学系,北京100191 [4]首都医科大学附属北京同仁医院眼科,北京100069

出　　处：《北京大学学报（医学版）》2018年第1期1-4,共4页Journal of Peking University:Health Sciences

基　　金：“十一五”国家科技支撑计划(2007BAI18B11); 国家自然科学基金(30730102;30171016、3034006、30371545、30640093、80170847、81470756、81271161、81170974、30700949、81300893)资助

摘　　要：干眼是泪膜异常导致的以角结膜干燥为主的眼表疾病,重症患者因眼干、视力减退甚至失明而严重影响生活质量。1998年以来,北京大学口腔医学院、基础医学院和首都医科大学北京同仁医院组成联合项目组,开展血管化自体下颌下腺移植治疗重症干眼的基础与临床紧密结合的系列研究,SUMMARY Severe dry eye is a refractory ophthalmologic disease. Our multidisciplinary research group treated severe dry eye by microvascular autologous transplantation of submandibular gland （SMG） during the past 20 years. The SMG, with its blood vessels and Wharton ＇s duct, was harvested from the subman-dibular triangle and transferred to the temporal area. The blood vessels in the SMG were anastomosed with the temporal blood vessels using a microsurgical technique. Then, the distal end of Wharton, s duct was sutured to form an opening in the upper lateral conjunctival fold. The tear was replaced by the secretion of the transplanted SMG to lubricate the ocular surface. In our study, the surgical techniques of blood vessel management were continuously modified to increase the survival rate of the transplanted SMG. A novel surgical modality of partial transplantation of SMG was established to prevent postoperative epipho-ra. A clinical study with the largest case number in the world was conducted and the effectiveness of transplantation of SMG for severe dry eye was fully confirmed. In order to resolve two main clinical prob-lems including ductal obstruction resulted from low secretion rate during the latent period, and epiphora due to over secretion of the transplanted SMG in the later term of transplantation, the regulation of the se-cretion mechanism of the normal and transplanted SMG were investigated. New opinions on mechanisms of saliva secretion were provided. Based on the priniciple of translational medicine, the results of related basic research were applied in the clinic. The clinical guidelines for secretion regulation of transplanted SMG were established. A concept of chronic obstructive sialadenitis of transplanted SMG was provided and its diagnostic criteria, diagnostic technique of sialography, and therapeutic regimen were established. As a result, the surgical success rate was obviously elevated, the surgical comp

关 键 词：下颌下腺 干眼 干燥性角结膜炎 移植 自体 泪器疾病 

分 类 号：R781.7[医药卫生—口腔医学]