异种脱细胞真皮植入术治疗甲状腺相关眼病眼睑退缩的临床观察  

Acellular xenogenic dermal matrix as a spacer graft for treatment of eyelid retraction related to thyroid associated ophthalmopathy

作　　者：庄艾 孙静[1] 张硕 周慧芳[1] Zhuang Ai;Sun Jing;Zhang Shuo;Zhou Huifang(Department of Ophthalmology,Shanghai Ninth People′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院眼科,上海市眼眶病眼肿瘤重点实验室,200011

出　　处：《中华眼科杂志》2019年第11期821-827,共7页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(81600766);上海市重点实验室资助(17DZ2260100);上海市“医苑新星”青年医师培养资助计划。

摘　　要：目的评估异种脱细胞真皮植入术治疗甲状腺相关眼病上睑和下睑退缩的疗效和安全性。方法回顾性系列病例研究。收集2016年1月至2017年12月上海交通大学医学院附属第九人民医院眼科诊断为甲状腺相关眼病眼睑退缩并行异种脱细胞真皮植入的患者资料。术后随访至少6个月,通过观察患眼眼部不适症状、眼睑位置及术后并发症,评估手术的疗效和安全性。术后疗效按睑裂高度、睑缘弧度、对称性等分为满意、良好和不理想。采用非参数秩和检验及Mann-Whitney U检验进行统计学分析。结果共纳入80例(102只眼)患者,其中上睑退缩43例(56只眼),包括34例女性(年龄中位数37岁)和9例男性(年龄中位数47岁);下睑退缩37例(46只眼),包括20例女性(年龄中位数39岁)和17例男性(年龄中位数40岁)。术后眼部症状得到完全缓解或部分改善,其中79.0%(64/81)的患眼眼部不适完全缓解,69.5%(41/59)的患眼畏光完全缓解,94.9%(37/39)的患眼流泪完全缓解,80.7%(67/83)的患眼眼睑闭合不全完全缓解。上睑退缩患者角膜映光点到上睑缘垂直距离由术前8.0(7.5,8.0)mm降至术后3.5(3.4,4.0)mm(Z=-6.587);上方巩膜暴露由术前3.0(3.0,3.5)mm降至术后0 mm(Z=-6.616),手术前、后差异均有统计学意义(均P<0.01)。下睑退缩患者角膜映光点到下睑缘垂直距离由术前8.5(7.5,9.0)mm降至术后5.5(5.5,6.0)mm(Z=-5.979);下方巩膜暴露由术前3.0(2.5,3.5)mm降至术后0.0(0.0,0.5)mm(Z=-5.965),手术前、后差异均有统计学意义(均P<0.01)。总体疗效57例(71.3%)满意;18例(22.5%)良好;5例(6.3%)不理想,术后复发。上睑退缩患者中33例满意、8例良好、2例复发,下睑退缩患者中24例满意、10例良好、3例复发,二者间疗效差异无统计学意义(Z=-1.176,P>0.05)。未观察到感染、血肿、排斥反应等其他手术并发症。结论异种脱细胞真皮植入术可用于治疗甲状腺相关眼病引起的眼睑退缩,安全�Objective To evaluate the efficacy and safety of an acellular xenogenic dermal matrix(AXDM)as a spacer graft in the surgery to treat upper and/or lower eyelid retraction(UER/LER)in patients with thyroid associated ophthalmopathy(TAO).Methods This was a retrospective case series study.From January 2016 to December 2017,all the TAO patients who underwent the eyelid retraction surgery with an AXDM as a spacer graft in Shanghai Ninth People′s Hospital,Shanghai Jiaotong University School of Medicine were included in the study.The follow-up duration was at least 6 months.Eyelid height,ocular discomfort symptoms,and complications were recorded and used to evaluate the efficacy and safety.The treatment outcomes were divided into good,acceptable and unacceptable outcomes.Nonparametric test was used to compare the efficacy of upper and lower eyelid surgery.Results Eighty patients(102 eyes)were included,consisting of 43 patients(56 eyes)with UER and 37 patients(46 eyes)with LER.The UER patients included 34 females(median age,37 years)and 9 males(median age,47 years).The LER patients included 20 females(median age,39 years)and 17 males(median age,40 years).At 6 months after surgery,ocular discomfort was relieved in 79.0%(64/81)eyes;photophobia was relieved in 69.5%(41/59)eyes;tearing was relieved in 94.9%(37/39)eyes;lagophthalmos was relieved in 80.7%(67/83)eyes.In patients with UER,the margin reflex distance was lowered from 8.0(7.5,8.0)mm to 3.5(3.4,4.0)mm(Z=-6.587,P<0.01).The upper scleral show was lowered from 3.0(3.0,3.5)mm to 0 mm(Z=-6.616,P<0.01).In patients with LER,the margin reflex distance was lowered from 8.5(7.5,9.0)mm to 5.5(5.5,6.0)mm(Z=-5.979,P<0.01).The lower scleral show was lowered from 3.0(2.5,3.5)mm to 0.0(0.0,0.5)mm(Z=-5.965,P<0.01).In total,71.3%(57 cases)of the patients acquired good outcomes,22.5%(18 cases)acquired acceptable outcomes,and 6.3%(5 cases)had recurrence,and no significant difference was found between the patients with UER and LER(33,8,2 cases vs.24,10,3 cases,Z=-1.176,P>0.05).No other

关 键 词：GRAVES眼病 眼睑 脱细胞真皮 移植 异种 修复外科手术 

分 类 号：R73[医药卫生—肿瘤]