应用同种异体脱细胞真皮的眼睑原位重建术

The eyelid reconstruction in situ with allograft acellular dermal matrix

目的 探讨脱细胞真皮在眼睑缺损治疗中的临床效果。方法 2001年11月至2002年11月收治10例眼睑缺损患者(11只眼睑),其中上睑8例,下睑1例,同侧眼上下睑1例;外伤所致者9例,先天性缺损者1例;眼睑完全缺损2只睑, 2 /3缺损8只睑, 1 /3缺损1只睑。以厚度为1mm的商业化同种异体脱细胞真皮代替睑板,运用眼睑原位重建术治疗眼睑缺损。随访观察平均8个月。结果 脱细胞真皮植入眼睑后炎性反应轻微,未见有植入物脱落和感染现象,受体结膜可在脱细胞真皮表面爬行生长。组织学检查发现术后半年脱细胞真皮植片内有新生毛细血管和纤维母细胞存在。术后按治疗标准评为优者8只睑,良好2只睑,改善1只睑,治愈率为91%。结论 脱细胞真皮不仅能代替睑板起支撑作用,而且术后引起的免疫和炎性反应轻微,可作为一种生物支架引导受体新生血管和胶原纤维的长入。

Objective To explore the clinical value of allograft acellular dermal matrix in the treatment of eyelid defects. Methods From November 2001 to November 2002, 10 patients (8 male and 2 female; age varied from 14 to 47) with 11 eyelids were treated by eyelid reconstruction in situ with implantation of 1 mm thick allograft acellular dermal matrix. In 11 eyelids with defects, 2 was totally defect, 8 was 2/3 defect, 1 was 1/3 defect. In these 10 patients, 9 were injured and 1 was congenital. These defective eyelids included 8 upper lids, 1 lower lid and 1 case with both upper and lower!lids. The average follow-up time was 8 months. Results In the follow-up periods, the inflammation of the eyelid was slight and no implants shedding or infection happened postoperatively. The conjunctiva grew well on the surface of the acellular dermal matrix. Histology examination showed neovascularization and presence of fibroblasts in the acellular dermal matrix 6 months after the operation. By the end of the follow up period, the results were excellent in 8 eyelids, good in 2 eyelids and improved in 1 eyelid. The efficacy rate of this treatment was 91%. Conclusions Acellular dermal matrix can be used as a substitute of the tarsus in supporting the eyelid, it invokes little immunological and inflammatory reaction, and therefore, it can act as a biological scaffold to guide the growth of collagen and neovasculariztion.