血管化自体下颌下腺移植治疗重症角结膜干燥症的初步研究  

A Preliminary Study of Microvascular Autologous Submandibular Gland Transplantation in Treatment of Severe Cases of Keratoconjunctivitis Sicca

作　　者：马旭亮 任玉峰 蔡现良 王超 张培成 苏家增[4] MA Xuliang;REN Yufeng;CAI Xianliang;WANG Chao;ZHANG Peicheng;Su Jiazeng(Department of Oral and Maxillofacial Surgery,Hebei Eye Hospital;Department of Oral Implantology,Hebei Eye Hospital;Hebei Provincial Institute of Ophthalmology,Xingtai 054001,Hebei Province;Department of Oral and Maxillofacial Surgery,Peking University Hospital of Stomatology,Beijing 100081,China)

机构地区：[1]河北省眼科医院口腔颌面外科 [2]河北省眼科医院口腔种植科 [3]河北省眼科研究所,河北邢台054001 [4]北京大学口腔医院口腔颌面外科,北京100081

出　　处：《口腔颌面外科杂志》2021年第1期42-46,共5页Journal of Oral and Maxillofacial Surgery

摘　　要：目的:应用血管化自体下颌下腺移植的方法治疗重症角结膜干燥症,并评价其疗效。方法:纳入重症角结膜干燥症患者4例,将患者下颌下腺移植至颞部,完成血管吻合,并将移植腺体导管重新开口于患眼。术后监测移植腺体血运并调控其分泌功能,对患眼治疗效果进行评估。结果:2017—2019年共治疗了4例患者的5只眼,其中1例接受双侧眼部手术。所有患者手术均获成功,核素显像证实移植腺体均成活。经术后功能调控治疗,移植腺体分泌适当。随访结果显示:希尔默试验由术前的0 mm/5 min升至术后的15 mm/5 min;眼表结构改善明显,泪膜破裂时间由术前的0 s增加至术后6 s;患者角膜荧光染色评分降低,视力出现不同程度的提高。主观评价结果显示,患者术后眼干症状改善,所有患者均停止使用人工泪液。结论:在具备显微外科技术的条件下,自体下颌下腺移植手术的成功率较高,是治疗重症角结膜干燥症的有效方法。Objective:Microvascular autologous submandibular gland transplantation was used to treat severe cases of keratoconjunctivitis sicca,and its curative effect was evaluated.Methods:A total of 4 patients of severe keratoconjunctivitis sicca were included.Submandibular glands were transplanted to the temporal region with anastomosis of the vessels.The submandibular gland were re-opened into the eyes.Blood circulation of the transplanted glands was monitored and the secretory function was artificially regulated.The therapeutic effect of the patients was evaluated.Results:From 2017 to 2019,submandibular gland transplantation was performed in 5 eyes of 4 patients(bilateral transplantations in one patient).All surgeries were successful with graft vitality confirmed by scintigraphy.Lubrication of the eyes was suitable after regulation of the secretory function of the grafts.Follow-up results showed that mean Schirmer’s test values increased from a preoperative level of 0 mm/5 min to 15 mm/5 min postoperatively,and tear film break-up time(BUT)improved from 0 s to 6 s.Fluorescein(FI)scores reduced and postoperative best-corrected visual acuity improved.The result of subjective evaluation showed that the symptoms of dry eye were improved and use of artificial tear substitutes was discontinued in all patients.Conclusion:Based on the technology of microsurgery,the submandibular gland transplantation surgery can be successfully handled and used as an effective treatment method for severe keratoconjunctivitis sicca.

关 键 词：下颌下腺移植 角结膜干燥症 显微外科 

分 类 号：R782[医药卫生—口腔医学]