多层新鲜羊膜移植联合结膜囊成形术治疗结膜囊狭窄

Clinical study on fresh multilayer amniotic membrane transplantation combined with conjunctival reconstruction for treatment of conjunctival sac stenosis

目的：探讨多层新鲜羊膜移植术治疗结膜囊狭窄的临床疗效。方法：对52例（52眼）结膜囊狭窄、无法安装义眼的患者行结膜囊成形术，根据结膜囊狭窄的不同程度分为3组。将2～3层新鲜羊膜上皮面朝上移植于结膜缺损区，上下睑缘褥式缝合。每周打开眼睑并用荧光素试纸染色，观察结膜上皮生长情况。术后3mo拆除上下眼睑缝线，定制合适的义眼。结果：术后随访12mo。术后4wk51眼羊膜表面全部被结膜上皮覆盖，有1眼发生羊膜上皮融解，结膜上皮未愈。术后3moⅠ度结膜囊狭窄（A组）15眼全部治愈；Ⅱ度结膜囊狭窄（B组）17眼中15眼治愈，2眼好转；Ⅲ度结膜囊狭窄（C组）20眼中16眼治愈，3眼好转，1眼无效。Ⅲ度结膜囊狭窄患者手术成功率与Ⅰ度、Ⅱ度结膜囊狭窄患者比较，其差异无显著性意义（P〉0．05）。结论：多层新鲜羊膜移植联合结膜囊成形术是治疗结膜囊狭窄的有效方法，同样适用于重度结膜囊狭窄。

AIM： To observe the therapeutic effect of fresh multilayer amniotic membrane transplantation combined with conjunctival reconstruction for treatment of conjunctival sac stenosis. METHODS： Fifty-two patients （52 eyes） suffered from conjuctival sac stenosis were treated with fresh multilayer amniotic membrane transplantation. The superior and lower eyelid was closed with mattress suture. The eyelids were opened and stained with fluorescein test paper every week in order to observe the growth of conjunctival epithelium. Stitches were removed three months after surgery and the suitable prosthesis was made. RESULTS： Conjunctival epithelium migrated to the surface of the amniotic membrane and covered it completely in 51 cases four weeks after surgery. Amniotic membrane was dissolved and conjunctival epithelium could not cover the defect area in one case. Three months after surgery, 15 eyes of degree C[ ] cojunctival sac constriction （group A） were all cured. In degree C cojunctival sac constriction （group B） ,15 eyes were cured and two eyes were improved. In degree C cojunctival sac constriction （group C）,16 eyes were cured, 3 eyes were improved and 1 eye failed. There was no statistical difference of success rate between three groups. CONCLUSION. Fresh multilayer amniotic membrane transplantation combined with conjunctival reconstruction is effective for treatment of conjunctival sac stenosis of degree C[ ] and C .