新鲜羊膜移植在结膜囊成形术中的应用

APPLICATION OF FRESH AMNIOTIC MEMBRANE TRANSPLANTATION IN TREATMENT OF STENOSIS OF CONJUNCTIVAL SAC

目的 探讨新鲜人羊膜移植治疗结膜囊狭窄临床应用的可行性及疗效。 方法 2 0 0 1年 3月～ 2 0 0 3年 3月 ,用新鲜羊膜对 30例 ( 30只眼 )结膜囊狭窄患者行羊膜移植结膜囊成形术。术前在无菌条件下切取羊膜组织 ,将其上皮面向上平铺于手术粘贴纸上 ,剪成 5 cm× 8cm大小数块 ,放入含庆大霉素 ( 4× 10 6 U/ ml)生理盐水的密封湿房中 ,4℃冰箱保存 12小时。术中充分分离球结膜与筋膜组织达眶缘 ,游离并剪除结膜下粘连的瘢痕组织 ,修剪羊膜组织使其稍大于结膜缺损区约 10 mm,其上皮面向上置于结膜缺损区 ,用 7/ 0尼龙线将其连续缝合于结膜游离创缘上 ;同时行下穹窿加深成形术 ,部分患者行羟基磷灰石义眼座二期植入术和 /或外伤性上睑下垂矫正术。 结果 30例 ( 30只眼 )均于术后 10、14天拆除羊膜移植缝线及下穹窿加深成形术缝线 ,所有移植羊膜均成活 ,结膜囊下穹窿充分加深 ,配戴义眼效果满意。术后随访 3～ 18个月 ,未发现植片感染、挛缩 ,以及免疫排斥反应和羊膜溶解 ,手术获得成功。 结论 新鲜人羊膜移植部分结膜囊成形术是一种取材简便。

Objective To evaluate the clinical efficiency of fresh amniotic membrane transplantation in treatment of stenosis of conjunctival sac. Methods Thirty cases (30 eyes) of stenosis of conjunctival sac were treated with fresh amniotic membrane transplantation. Amniotic membrane was obtained under sterile conditions after elective cesarean delivery. The woman's serum was negative for HBsAg, syphilis, and human immunodeficiency virus. The placenta was first washed free of blood clots with sterile saline. Under sterile conditions, the inner amniotic membrane was separated from the chorion by blunt dissection, and was cleaned of blood with the sterile saline again. The membrane was then flattened onto a surgidrape adhesive paper with the epithelium surface up. The paper with the adherent amniotic membrane was then cut into 5 cm×8 cm pieces, and then rinsed in solution containing 4×10 6 U/L of gentamycin and stored at 4℃. It could be stored for 12 hours after preparation. The adhesiotomy was performed firstly. The separation between the conjunctiva and scar tissue should be complete and wide enough to reach to the orbital margin. The adhesiectomy was taken secondly. The scar tissues were removed completely. The fresh amniotic membrane was flattened onto the conjunctival defect with epithelium side up. The fresh amniotic membrane was 10 mm more than the conjunctival defect by trimming off the excess portion. This fashioned membrane was then secured to surrounding conjunctival edge with continuous 7 0 nylon sutures. The necessary mattress suture of inferior conjunctival fornix via skin next to the inferior orbital margin was performed simultaneously. The retrobular implantation of the an artificial globe made of hydroxyapatite was performed on some patients with sunken eye. Correction of traumatic ptosis was performed on a few patients. Results The operation of reconstruction of partial conjunctival sac for 30 cases was successful. All amniotic membrane grafts were alive. The cosmetic result was complete favorable. The infection and contracture of the graft, immunologic rejection and amniotic lysis were not observed in all cases during the follow up period of 13 18 months. Conclusion Fresh amniotic membrane transplantation can be used in reconstruction of the partial conjunctival sac effectively and can be popularized in the local hospital in China because the amniotic membrane can be obtained easily.