自制简易羊膜固定器治疗兔眼化学性烧伤的实验观察

Self-made amniotic membrane fixation equipment for rabbit ocular surface chemical burns

目的探讨应用自制简易环形羊膜固定器固定羊膜行羊膜覆盖术治疗兔眼化学性眼表烧伤的可行性。方法将40只(40眼)新西兰大白兔,随机分为实验组与对照组,每组各20只(20眼),均取左眼为实验眼,制成中度碱烧伤模型。实验组采用自制羊膜固定器将羊膜固定于眼表行羊膜覆盖术,对照组采用常规缝线法固定羊膜行羊膜覆盖术。1周内每天随访1次,之后1周检查1次,连续检查1个月。1个月内根据羊膜破损情况,5~10 d更换新鲜羊膜。记录手术时间并观察两组眼表羊膜下积液、睑球粘连的发生率,并对1个月后角膜新生血管及角膜混浊度进行评分。结果实验组手术时间(16.65±2.64)min,角膜新生血管评分(1.80±0.76)分,角膜混浊度评分(1.85±0.58)分,羊膜下积液率10%,睑球粘连率5%,角膜上皮愈合率80%,角膜上皮愈合时间(23.25±3.08)d。对照组手术时间(39.40±5.87)min,角膜新生血管评分(2.20±0.69)分,角膜混浊度评分(2.00±0.64)分,羊膜下积液率45%,睑球粘连率35%,角膜上皮愈合率65%,角膜上皮愈合时间(26.15±2.85)d。两组手术时间、角膜上皮愈合时间、羊膜下积液率及睑球粘连率相比差异均有统计学意义(均为P【0.05);角膜上皮愈合率术后1个月角膜新生血管及角膜混浊度评分差异均无统计学意义(均为P】0.05)。结论应用自制简易环形羊膜固定器可缩短手术时间及角膜上皮愈合时间,多次重复手术,减少晚期严重并发症的发生。该固定器具有性质稳定、制作材料易获取、价格低廉等特点,适用于偏远基层医院眼科。

Objective To observe the feasibility of fixing amniotic membrane by self-made amnion fixation equipment in the treatment of rabbit ocular surface chemical burns.Methods Forty rabbits(40 eyes)were divided into the experimental group and control group randomly with 20 cases in each group,the left eye was established the moderate chemical burn model.Twenty cases in the experimental group were performed amniotic membrane transplantation fixed by self-made amnion fixation equipment and those in the control group were performed amniotic membrane covering with routine suturation.The follow-up time was once per day in one week,then once per week in one month.Based on the breakage of amniotic membrane in one month,the fresh amniotic membrane was replaced from 5 days to 10 days.The surgical time was recorded,the incidence of hydrops under amniotic membrane and symblepharon were observed and the corneal neovascularization and opacity were also scored at postoperative 1 month.Results In the experimental group,the average surgical time was(16.65±2.64)minutes score of corneal neovascularization was(1.80±0.76)points score of corneal opacity was(1.85±0.58)points,incidence rate of symblepharon hydrops and corneal epithelization were 5%,10%and 80%,respectively,porneal epithelization time was(23.25±3.08)days.In the control group,the average surgical time was(39.40±5.87)minutes,score of corneal neovascularization was(2.20±0.69)points score of corneal opacity was(2.00±0.64)points, incidence rate of symblepharon,hydrops and corneal epithelization were 35%,45%and 65%,respectively corneal epithelization time was(26.15±2.85)days.There were statistical differences in surgical time,corneal epithelization time,hydrops and symblepharon between two groups(all P<0.05).Condusion The application of self-made amnion fixation equipment can reduce the surgical time and corneal epithelization time,avoids the serious complications.The self-made amnion fixation equipment is cheap available and stable, which is suitable for remote primary hospital.