基层医院治疗眼表重度烧伤的困境和对策的探讨

Difficulty and strategy of treatment for severe eye burns in basic hospital

目的探讨在缺乏异体角膜供体情况下治疗Ⅲ度以上眼表烧伤的手术方式及疗效。方法眼表重度烧伤35例（37眼）。其中28例（29眼）Ⅲ度烧伤，行自体带角膜缘干细胞结膜瓣移植联合新鲜羊膜遮盖术；7例（8眼）IV度烧伤采取双层羊膜遮盖术，二期行带角膜缘干细胞结膜瓣移植联合新鲜羊膜遮盖。术后若羊膜脱落则再次行羊膜遮盖直至角膜上皮完全修复。结果术后随访3～20个月，35例（37眼）中19眼角膜恢复透明，11眼角膜薄翳（共30眼判断为治愈），4眼瘢痕愈合（角膜白斑、新生血管长入），2眼石灰烧伤角膜溃疡无法愈合需行结膜瓣遮盖，1眼爆炸伤最终角膜穿孔、感染需眼球摘除（共7眼判断为无效），治愈率81．08％。共需羊膜遮盖1～4次。结论带角膜缘干细胞结膜瓣移植联合多次新鲜羊膜遮盖术治疗重症眼烧伤，在基层综合医院取材方便，价廉，具可操作性，对Ⅲ度烧伤有减轻炎症、促进眼表上皮化、提高视力等效果；对Ⅳ度烧伤有保存眼球、防止睑球粘连的治疗意义，在缺乏异体角膜供体情况下可选择应用。

Objective To investigate methods and curative effect of treatment for corneal burn above degree m without corneal donator. Methods Among 35 eases（37eyes）,28 cases （29eyes） burnt eyes in degree m were treated with amniotic membrane overlay combined with limbus eorneae transplantation. 7 cases （8eyes） burnt eyes in degree IV were treated with double - deck amniotic membrane overlay. At second times, these 8 eyes were treated combined with limbus corneae stem cell transplantation. If the amniotie membrane amotio from cornea, these eyes were treated with amniotic membrane overlay second times until the epithelia is healed with stability. Results Patients were followed up for 3 - 20 months . Among 35 cases （37 eyes）, there was corneal transparence in 19 eyes. There was semitransparency in 11 eyes. （30 eyes were con- sidered healing well）. There was neovascularization in 4 eyes. There was non - healing corneal anabrosis in 2 eyes burnt by lime, which were treated with conjunctival flap overlay. There was corneal perforation and infection in one eye burnt by detonation. This eye was extirpated finally. （7 eyes was ineffective. ）. Healing rate was 81.08%. Amniotic membrane overlay was applied 1 -4 times. Conclusion Amniotic membrane overlay combined with stem - cell transplantation of limbus corneae was effective for the eye burns in degree III. In basic hospital, amniotic membrane is easy to draw the materials from other patient and the operation charge is lower. Such operation can effectively mitigate inflammation, heal epithelia and enhance visual capacity. For eye burns in degree IV, the objective of operation is conserving bulbus oculi and preventing symblepharon. Without without corneal donator, amniotic membrane overlay combined with stem - cell transplantation of limbus comeae is a correct operation for eye bums above degree III.