新鲜羊膜在儿童调整显微斜视手术中的应用观察(1)
摘 要 目的 探讨新鲜羊膜在儿童调整显微斜视矫正手术中的临床应用疗效。方法 采用新鲜羊膜移植联合直肌后徙缝线调整术治疗儿童共同性斜视18例36眼，术后随访均大于6个月。结果 18例患儿术后均能配合眼位检查及眼位调整，调整后眼位基本满意；术后1周，眼位可调整12例24眼,可调整率为66.67%，眼位可调整量平均为5.30mm，术后5周，眼位可调整8例15眼，可调整率为41.67%，眼位可调整量平均为3.05mm；术后眼位可调整率及可调整量均明显高于单纯直肌后徙缝线调整术。结论 儿童调整显微斜视手术中应用新鲜羊膜安全有效，值得临床推广。
关键词羊膜；斜视矫正术；眼位调整
Application of fresh amniotic membrane in for adjustable microscopic strabismus surgery in childhood
Tan Yehui,Zeng Guangchuan,Niao Wu,Qiu Fangfang,Jia Xiaojing.Department of Ophthalmology,Yue Bei People's Hospital, South Huimin Road, Shaoguan, Guangdong,512026,China.
, 百拇医药
AbstractObjective This study is to discuss the clinical efficacy of fresh amniotic membrane during the adjustable microscopic strabismus surgery in children. MethodsTransplantations of fresh amniotic membrane combined with rectus muscle recession combined adjustable suture were adopted in 18 cases (36 eyes) of children with concomitant strabismus.All the patients were followed-up over 6 months after the adjustable microscopic strabismus surgery.Results All of 18 cases of children can cooperate with eyeposition examination and adjustment after strabismus surgery. The adjusted eyepositions were satisfied mainly. At one week after surgery，Eyepositionof12 cases(24 eyes) can be adjusted, with the adjustment rate was 66.67% and the average of adjustment lengths is 5.30mm.At five weeks after surgery，Eyepositionof8 cases (15 eyes) can be adjusted, with the adjustment rate was 41.67% and the average of adjustment lengths is 3.05mm. The adjustment rate and the adjustment lengths were higher than that of rectus muscle recession combined adjustable suture. Conclusion The application of fresh amniotic membrane in adjustable microscopic surgery is effective and safe in the treatment ofstrabismus in children and is worth spreading in clinic.
, 百拇医药
Key wordsamniotic membrane;strabismus surgery; eyeposition adjustment
斜视是儿童常见及多发眼病之一,儿童斜视早期手术治疗已经得到了公认, 但儿童斜视矫正手术，因其特殊的生理特点，绝大多数均需在全身麻醉状态下进行，因术中无法配合眼位调整，儿童斜视术后预期结果的可靠性较低，多采用术后眼位调整方法来提高疗效，国内外大量研究证明缝线调整斜视矫正术是儿童斜视矫正术后短时间内调整眼位的一种有效方法[1],但传统的调整缝线术存在一些不可避免的问题,尤其是调整缝线与周围组织的粘连和瘢痕形成是长期困扰眼科医生的难题。我们应用新鲜羊膜对传统的调整缝线手术做了改进，自2010年6月并将此项技术应用于儿童显微斜视手术中,取得了良好的临床效果,现将结果报告如下。
资料与方法
一、一般资料
, http://www.100md.com
2010年6月至2013年12月在我院行斜视矫正手术的共同性斜视患儿38例，其中男18例,女20例，年龄8～12岁,平均10.5岁，所有患儿均采用显微镜下直肌后徙调整缝线术,并根据术中是否应用新鲜羊膜随机分成A、B两组:A组18例(36眼)行直肌后徙调整缝线联合新鲜羊膜移植术, B组20例(40
课题基金：韶关市医药卫生科研计划项目(Y12156)
作者单位：512026，韶关,广东省粤北人民医院眼科
通讯作者：谭叶辉，Email：yehuit520@163.com
眼)行单纯直肌后徙调整缝线术,两组患者在例(眼)数,性别,年龄,斜视度大小之间比较均无显著性差异(P>0.05)，具有可比性。
二、新鲜羊膜的取材与制备
, 百拇医药
按照Lee等(1997年)的报道方法[2], 选择无传染性疾患即产前血清学检查均为阴性的健康剖宫产的产妇, 产后立即取自胎盘,在无菌条件下用生理盐水冲洗干净,羊膜取自所选产妇的胎盘。羊膜取出后用含青霉素、链霉素、两性霉素B的的Earle平衡盐液清洗,钝性剥离绒毛膜并尽量去除羊膜的海绵层组织。于4℃冰箱中8小时内新鲜状态下使用或保存在100%甘油中备用。
三、手术方法
1.直肌后徙调整缝线术:所有患儿均为全身麻醉手术,作改良PARK结膜切口,钩全眼外肌,剪断节制韧带及肌间膜,以6-0双铲针可吸收缝线于肌肉附着点后1.5mm处,板层穿过肌肉2/3宽度,再于肌肉两侧边缘作约1/3肌肉宽度的双套环缝合,注意缝线时要带全肌肉肌鞘,以免肌肉滑脱;剪断肌肉,清理肌肉附着点处筋膜,缝线自肌肉附着点中央呈八字穿出浅层巩膜处,两针间距保持附着点后2～3mm,附着点前0～0.5mm再将球结膜复位后将两肌肉缝线于球结膜对应部位穿出,拉紧缝线, 5-0慕丝线于肌肉后徙长度处打套环结,预留2mm再打结,形成一个调整线环,再将肌肉缝线预留约3mm长度处结扎,以斜视钩将肌肉还纳至后徙部位,并使缝线拉紧,对合关闭结膜切口。, 百拇医药(谭叶辉 曾广川 廖武 邱芳芳 贾晓静)
关键词羊膜；斜视矫正术；眼位调整
Application of fresh amniotic membrane in for adjustable microscopic strabismus surgery in childhood
Tan Yehui,Zeng Guangchuan,Niao Wu,Qiu Fangfang,Jia Xiaojing.Department of Ophthalmology,Yue Bei People's Hospital, South Huimin Road, Shaoguan, Guangdong,512026,China.
, 百拇医药
AbstractObjective This study is to discuss the clinical efficacy of fresh amniotic membrane during the adjustable microscopic strabismus surgery in children. MethodsTransplantations of fresh amniotic membrane combined with rectus muscle recession combined adjustable suture were adopted in 18 cases (36 eyes) of children with concomitant strabismus.All the patients were followed-up over 6 months after the adjustable microscopic strabismus surgery.Results All of 18 cases of children can cooperate with eyeposition examination and adjustment after strabismus surgery. The adjusted eyepositions were satisfied mainly. At one week after surgery，Eyepositionof12 cases(24 eyes) can be adjusted, with the adjustment rate was 66.67% and the average of adjustment lengths is 5.30mm.At five weeks after surgery，Eyepositionof8 cases (15 eyes) can be adjusted, with the adjustment rate was 41.67% and the average of adjustment lengths is 3.05mm. The adjustment rate and the adjustment lengths were higher than that of rectus muscle recession combined adjustable suture. Conclusion The application of fresh amniotic membrane in adjustable microscopic surgery is effective and safe in the treatment ofstrabismus in children and is worth spreading in clinic.
, 百拇医药
Key wordsamniotic membrane;strabismus surgery; eyeposition adjustment
斜视是儿童常见及多发眼病之一,儿童斜视早期手术治疗已经得到了公认, 但儿童斜视矫正手术，因其特殊的生理特点，绝大多数均需在全身麻醉状态下进行，因术中无法配合眼位调整，儿童斜视术后预期结果的可靠性较低，多采用术后眼位调整方法来提高疗效，国内外大量研究证明缝线调整斜视矫正术是儿童斜视矫正术后短时间内调整眼位的一种有效方法[1],但传统的调整缝线术存在一些不可避免的问题,尤其是调整缝线与周围组织的粘连和瘢痕形成是长期困扰眼科医生的难题。我们应用新鲜羊膜对传统的调整缝线手术做了改进，自2010年6月并将此项技术应用于儿童显微斜视手术中,取得了良好的临床效果,现将结果报告如下。
资料与方法
一、一般资料
, http://www.100md.com
2010年6月至2013年12月在我院行斜视矫正手术的共同性斜视患儿38例，其中男18例,女20例，年龄8～12岁,平均10.5岁，所有患儿均采用显微镜下直肌后徙调整缝线术,并根据术中是否应用新鲜羊膜随机分成A、B两组:A组18例(36眼)行直肌后徙调整缝线联合新鲜羊膜移植术, B组20例(40
课题基金：韶关市医药卫生科研计划项目(Y12156)
作者单位：512026，韶关,广东省粤北人民医院眼科
通讯作者：谭叶辉，Email：yehuit520@163.com
眼)行单纯直肌后徙调整缝线术,两组患者在例(眼)数,性别,年龄,斜视度大小之间比较均无显著性差异(P>0.05)，具有可比性。
二、新鲜羊膜的取材与制备
, 百拇医药
按照Lee等(1997年)的报道方法[2], 选择无传染性疾患即产前血清学检查均为阴性的健康剖宫产的产妇, 产后立即取自胎盘,在无菌条件下用生理盐水冲洗干净,羊膜取自所选产妇的胎盘。羊膜取出后用含青霉素、链霉素、两性霉素B的的Earle平衡盐液清洗,钝性剥离绒毛膜并尽量去除羊膜的海绵层组织。于4℃冰箱中8小时内新鲜状态下使用或保存在100%甘油中备用。
三、手术方法
1.直肌后徙调整缝线术:所有患儿均为全身麻醉手术,作改良PARK结膜切口,钩全眼外肌,剪断节制韧带及肌间膜,以6-0双铲针可吸收缝线于肌肉附着点后1.5mm处,板层穿过肌肉2/3宽度,再于肌肉两侧边缘作约1/3肌肉宽度的双套环缝合,注意缝线时要带全肌肉肌鞘,以免肌肉滑脱;剪断肌肉,清理肌肉附着点处筋膜,缝线自肌肉附着点中央呈八字穿出浅层巩膜处,两针间距保持附着点后2～3mm,附着点前0～0.5mm再将球结膜复位后将两肌肉缝线于球结膜对应部位穿出,拉紧缝线, 5-0慕丝线于肌肉后徙长度处打套环结,预留2mm再打结,形成一个调整线环,再将肌肉缝线预留约3mm长度处结扎,以斜视钩将肌肉还纳至后徙部位,并使缝线拉紧,对合关闭结膜切口。, 百拇医药(谭叶辉 曾广川 廖武 邱芳芳 贾晓静)
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