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目的:探讨一种保留假性翼状胬肉或粘连组织上皮,结合应用由眼表生物膜的固定装置制成的全结膜羊膜接触镜在重建眼表烧伤后睑球粘连性眼表的可行性、安全性和有效性。方法:将眼表烧伤致睑球粘连患者26例(26只眼),随机分为实验组与对照组各13例(13眼),实验组手术方法:分离并保留粘连组织,使其成为以穹隆为基底的组织片,后徙并固定其于睑结膜面,成形睑结膜和穹隆结膜,或部分替代球结膜;处理巩膜表面,尽量保留表层巩膜组织创面行羊膜移植重建结膜囊。手术完毕利用眼表生物膜的固定装置制成的全结膜囊羊膜接触镜置于结膜囊内,并行临时性睑缘缝合术,根据病情需要更换羊膜。对照组则彻底清除眼表粘连组织后根据创面大小行羊膜移植术,术后结膜囊置入角膜接触镜。术后随访3个月~1年,观察结膜上皮化时间、印迹细胞学检测、眼表炎症情况、羊膜病理检查以及睑球粘连复发情况并进行比较。结果:实验组平均上皮化时间为(13.2±4.7)d,对照组为(16.1±3.3)d,2组比较差异有统计学意义(P<0.01)。印迹细胞学检测:术前粘连区域见大量炎症细胞,结膜杯状细胞缺失或伴有结膜鳞状上皮化生,术后重建区域可见少量结膜杯状细胞,但密度较正常低;术后3个月泪液分泌试验显示实验组为(7.6±3.9)mm,对照组为(4.5±2.9)mm,2组比较差异有统计学意义(P<0.01);术后3个月泪膜破裂时间显示实验组为(7.0±1.3)s,对照组为(3.7±1.8)s,2组比较差异有统计学意义(P<0.01);保留的粘连组织片术后1个月后逐渐变薄,充血减轻,表面血管萎缩,3个月后在肉眼观察下与正常球结膜无明显差别。眼表炎症情况:根据更换的羊膜行组织病理学检查间接反映重建眼表的炎症情况,发现术后4周更换取出的羊膜基质仍可见炎症细胞浸润。睑球粘连手术成功率实验组为92.3%,对照组为61.5%,2组比较差异有统计学意义(P<0.05)。结论:在手术治疗睑球粘连重建眼表中,结合应用由眼表生物膜的固定装置制成的全结膜囊羊膜接触镜是一种简单有效的方法,可明显提高眼表重建手术的成功率。
OBJECTIVE: To investigate the feasibility of preserving the pseudopterygional pterygium or the adhesion epithelium, and combining the use of the whole conjunctiva amniotic contact lens made of fixation device of ocular surface biofilm to reconstruct the ocular surface of symblepharon after ocular surface burn. Safety and effectiveness. Methods: Twenty-six patients (26 eyes) with symblepharon burned under ocular surface burn were randomly divided into experimental group (13 eyes) and control group (13 eyes). The experimental group was divided into three groups: For the basal tissue membrane, after the migration and fixation of its conjunctiva surface, the formation of conjunctiva and dome conjunctiva, or partial replacement of the ball conjunctiva; treatment of the scleral surface, try to retain the surface of the scleral tissue amniotic membrane transplantation reconstruction conjunctival sac. Surgical use of ocular surface biofilm fixation device made of the whole conjunctiva amniotic contact lens placed in the conjunctival sac, concurrent temporary palpebral suture, as needed to replace the amniotic membrane. The control group was completely cleared of ocular surface adhesions tissue graft according to the size of the amniotic membrane transplantation, postoperative conjunctival sac into the contact lens. Postoperative follow-up of 3 months to 1 year, observed the time of conjunctival epithelialization, imprinting cytology, ocular inflammation, amniotic membrane pathology and syringomyelia recurrence and comparison. Results: The mean epithelialization time was (13.2 ± 4.7) days in the experimental group and (16.1 ± 3.3) days in the control group. The difference between the two groups was statistically significant (P <0.01). Imprinted cytology: a large number of inflammatory cells were observed in preoperative adhesion area, conjunctival goblet cells were missing or associated with conjunctival squamous metaplasia, postoperative reconstruction showed a small amount of conjunctival goblet cells, but the density was lower than normal; after 3 The monthly tear secretion test showed that the experimental group was (7.6 ± 3.9) mm and the control group was (4.5 ± 2.9) mm, the difference was statistically significant between the two groups (P <0.01); the tear film rupture time at 3 months showed that the experiment (7.0 ± 1.3) s in the control group and (3.7 ± 1.8) s in the control group, the difference between the two groups was statistically significant (P <0.01). The retained adhesions gradually thinned after 1 month and the congestion was relieved , Surface atrophy, 3 months after the naked eye with normal conjunctiva no significant difference. Ocular inflammation: According to the replacement of amniotic tissue histopathological examination indirectly reflect the reconstruction of ocular surface inflammation, found 4 weeks after the replacement of the amniotic membrane removed and still see inflammatory cell infiltration. The success rate of symblepharon surgery was 92.3% in the experimental group and 61.5% in the control group, with significant difference between the two groups (P <0.05). Conclusion: Surgical treatment of symblepharon reconstruction ocular surface, the combination of the use of ocular surface biofilm fixation device made of total conjunctival sac amniotic contact lens is a simple and effective method, can significantly improve the success rate of ocular surface reconstruction surgery .