染色脱细胞羊膜在II期义眼座置入并结膜囊成形术中的应用(1)
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[摘要]目的：探讨Ⅱ期义眼座直接置入联合染色脱细胞羊膜移植治疗结膜囊狭窄临床应用的可行性及疗效。方法：对38例(38只眼)眼球摘除术后眼窝内陷、结膜囊狭窄患者行Ⅱ期羟基磷灰石义眼座置入，同时用染色脱细胞羊膜移植治疗结膜囊狭窄。结果：术后随访3月，38例(38只眼)无1例感染。2周后，移植的羊膜透明，缝合处结膜向羊膜上爬行；1个月后新生的结膜上皮完全覆盖移植区。无义眼座暴露及脱出，无羊膜溶解及排斥反应发生。术后均能安装义眼。结论：Ⅱ期义眼座直接置入联合染色脱细胞羊膜移植结膜囊成形术是一种取材简便，方法简单，疗效肯定的手术方法。
[关键词]染色；脱细胞羊膜；结膜囊成形
[中图分类号]R779.64 [文献标识码]A [文章编号]1008-6455(2011)09-1340-02
Application of staining amnion extracellular matrix on secondary hydroxyapatite orbital implantation combined with conjunctival reconstruction
LIU YI1,LIU Feng-xia2,LIU De-cheng1,XU Lu-jia1
(1.Department of Ophthalmology,The 7th Hospital of Zhengzhou,Zhengzhou 450006,Henan,China; 2.Department of Ophthalmology,The 9th Hospital of Zhengzhou)
Abstract： ObjectiveTo observe the clinical effect of secondary hydroxyapatite orbital implantation combined with staining amnion extracellular matrix transplantation for reconstruction of conjunctival sac stenosis.Methods38 cases (38 eyes) suffered of conjunctival sac stenosis constriction were treated with secondary hydroxyapatite orbital implantation combined with staining amnion extracellular matrix transplantation. Stitches were removed three months after surgery and the suitable prosthesis was made.ResultsFollow-up 6 months 38 cases all got satisfied clinical effect amnion extracellular matrix emerged the normal colour and outward appearance of conjunctiva post-operation 1 month.No infection,necrosis or exclusion took place and good cosmetic effect were got after artificial eyes used.ConclusionIt was suggested that secondary hydroxyapatite orbital implantation combined with staining amnion extracellular matrix transplantation was convenient and safe on the reconstraction of conjunctival sac stenosis.
Key words：staining; amnion extracellular matrix；conjunctival sac stenosis
对于眼球摘除术后出现眼窝内陷、结膜囊狭窄导致不能安装义眼患者，通常行Ⅱ期羟基磷灰石义眼座置入联合结膜囊成形术治疗[1]。术中应用的羊膜具有促进上皮生长，减轻炎性反应和血管化及减少瘢痕的作用，所以利用羊膜进行结膜囊狭窄矫正的疗效基本肯定，但是由于羊膜的半透明性，术中不易观察，而且羊膜的超薄结构及黏着性强，尤其是脱细胞羊膜，在羊膜移植手术中极易卷曲、皱褶甚至破裂，增加了手术操作的难度。我们用2.5g/L荧光素钠染色脱细胞羊膜，使羊膜带有颜色，在显微镜下清晰可辨，使手术操作变得简便易行，术后效果也较为满意。
1资料和方法
1.1临床资料:选择2010年1月～2010年12月，在我院接受Ⅱ期义眼座置入术同时采用染色脱细胞羊膜移植结膜囊成形术的38例(38只眼)患者，其中男性29 例(29只眼)，女性9例(9只眼)，年龄15～54岁，平均23岁。患者眼球摘除的原因：其中外伤29例(化学伤2例，跟球破裂伤22例，爆炸伤5例)，绝对期青光眼眼球摘除术后7例 ......
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