α-氰基丙烯酸正丁酯用于皮肤结膜裂伤修复的实验研究

Experimental study on reparation of conjunctival and skin laceration with α-cyanoacrylate

背景使用组织黏合剂对眼表损伤进行修复的临床疗效已得到证实，但是其对眼表环境的影响尚不清楚。目的评价α-氰基丙烯酸正丁酯治疗皮肤、结膜裂伤的安全性和有效性。方法20只健康新西兰兔按随机数字表法随机分成医用胶组和缝线组，先行常规眼部检查，检测泪液分泌量和泪膜破裂时间（BUT）。表面麻醉后全层剪开右眼上方球结膜，长1．0cm；局部麻醉后全层切开背部皮肤，长约2．5cm，医用胶组使用α-氰基丙烯酸正丁酯黏合结膜及皮肤切口，缝线组用5．0丝线连续缝合结膜及间断缝合皮肤切口，术后1、2、7d行常规检查并检测实验眼泪液分泌量及BUT，观察切口愈合情况。1周后处死动物，切取相应组织进行病理学检查。应用SPSS13．0统计学软件进行统计分析。结果医用胶组和缝线组结膜和皮肤切口均愈合良好。医用胶组术后1d、2d的泪液分泌量分别为（12．70±2．21）mm和（12．70±2．00）mm，明显低于缝线组的（14．90±2．38）mm和（14．90±2．33）mm，相同时间点2个组间比较差异均有统计学意义（q=-4．02，P=0．03；q=-4．02，P=0．03）；与基线值相比，医用胶组术后各时间点的泪液分泌量差异均无统计学意义（P=1．00、1．00、0．51）。医用胶组术后2d、7d的BUT值分别为（4．50±1．18）S和（4．10±0．88）S，均明显长于缝线组的（3．30±1．06）S和（3．00±1．25）S，差异均有统计学意义（q=4．37，P=0．02；q=4．19，P=0．03）；术后1、2、7d的BUT值与基线值相比差异均无统计学意义（P=0．28、0．59、0．21）。缝线组各时间点BUT值较基线值明显缩短，差异均有统计学意义（P：0．01、0．01、0．00）。角膜组织病理学检查发现，各组兔结膜及皮肤切口均愈合，缝线组结膜组织有轻度胶原增生，而医用胶组炎性细胞浸润更为明显；缝线组皮肤表皮瘢痕增生，存在严重的胶原纤维增生，而医用胶组胶原增生情况明显轻于缝线组，表皮及真皮等组织结构接近正常。结论α-氰基丙烯酸正丁酯用于新西兰兔结膜和皮肤伤VI的黏合对眼表的环境影响较小，有效性和安全性较好。

Background The effectiveness of medical tissue adhesive for the reparation of operative incision has been recognized,but its influence to ocular surface mieroenvironment is not quite clear. Objective This study was to appraise the safety and efficacy ofα-cyanoacrylate, a medical issue adhesive, for the reparation of the conjunctival and skin laceration. Methods Twenty healthy New Zealand rabbits were randomly divided into suturing group and medical glue group. Routine ophthalmic examination, the level of tear secretion and breakup time of tear film （BUT） were tested before operation. The upper bulbar eonjunetiva of each right eye was cut apart about 1.0 cm after surface anesthesia and the skin of back was incised about 2.5 em length after local anesthesia. The conjunctival and skin lacerations were adhered with compound medical adhesive in the medical glue group, and continuous suture was done to repair the eonjunctival laceration and interrupted suture to the skin laceration with 5-0 ehorda serica ehirurgicalis in the suture group. The routine ophthalmic examination,level of tear secretion, BUT and the states of wound healing were examined 1 day,2 days and 7 days postoperatively. Pathologic examination of the corresponding tissues was also carried out 1 week after the animals were sacrificed. The data were analyzed by SPSS 13.0 statistical software. This experiment followed the Administration of the Care and Use of Experimental Animals of Shanghai City. Results The eonjunctival and skin lacerations healed well both in the suture group and the medical glue group. The levels of tear secretion 1 day and 2 days postoperatively in the medical glue group were （ 12.70 ± 2.21 ） mm and （12.70_±2.00） mm respectively, showing a significant lowness in comparison with （14.90_±2.38） mm and （ 14.90~2.33 ） mm of the suture group （ q = -4.02 ,P= 0.03 ;q = -4.02 ,P = 0. 03 ）. Compared with the baseline, the difference of the levels of tear secretion in the medical glue group was not statistically significant in various time points after operation （P= 1.00,1.00,0.51 ）. The BUT values at 2 days and 7 days postoperatively in the medical glue group were （4.50± 1. 18 ） seconds and （4. 10±0.88 ） seconds respectively, being significantly longer than （ 3.30± 1.06 ） seconds and （ 3.00± 1.25 ） seconds in the suture group （ q = 4.37, P = 0. 02 ; q = 4. 19, P = 0.03 ）. Compared with the baseline, there was not statistically significant difference at each time point postoperatively in the medical glue group （P = 0. 28,0. 59,0. 21 ）. However, BUT at each time point after operation in the suture group was significantly shorter than that of the baseline （P = 0. 01,0.01,0.00）. Pathological examination showed that all the conjunetiva] and skin lacerations healed well. Trivial collagen hyperplasy was seen in the eyes of the suture group and infiltration of a few of inflammatory cells was found in the medical glue group. In the pathological result of the skin test, there was conspicuous scar and severe collagen hyperplasy in the suture group,but in the medical glue group,the skin structure was almost normal. Conclusions α-Cyanoacrylate is safe and effective for the repair of the eonjunetival incision with little affection to ocular surface microenvironment.