保存异体睑板修复睑板缺损的临床观察

A clinical observation of preserved donor tarsal plate transplantation for repair of tarsus defect

目的 观察眼睑肿瘤术后保存异体睑板Ⅰ期修复睑板缺损的疗效。方法 采用纯甘油保存的异体睑板 ,对 5 8例眼睑肿瘤切除术后的患者行Ⅰ期睑板缺损修补术 ,用转位或滑行肌皮瓣和结膜瓣铺衬于异体睑板两侧。分析异体睑板的血运环境、异体睑板大小、保存时间与手术疗效的关系。术后随访 3个月至 10 5年 ,平均 1 8年。结果 5 8例中 ,43例异体睑板结膜瓣遮盖完全 ,术后1周异体睑板内可见新生血管 ,1个月后新生血管布满整个植片 ;15例异体睑板结膜瓣遮盖不全 ,术后 2～ 3个月新生血管长满植片 ,而裸露部位的植片表层可见不同程度的融解。不同大小结膜瓣间的植片愈合效果比较 ,差异有显著性 (χ2 =5 81,P <0 0 5 )。不同大小的异体睑板间疗效比较 ,差异有显著性 (χ2 =6 82 ,P <0 0 5 )。不同时间保存的异体睑板修复睑板缺损的疗效比较 ,差异无显著性(χ2 =0 99,P >0 0 5 )。3例保留异体睑板睫毛 ,术后 1个月睫毛全部脱落。术后 2 7例出现不同程度的眼睑内翻、外翻、眼睑闭合不全、睑缘切迹及异体睑板变薄 ,但眼睑外观及功能均正常。 5 8例中 ,治愈31例 ,显效 11例 ,改善 12例 ,失败 4例。结论 异体睑板的血管化及异体睑板的大小与手术效果有关 ,而与异体睑板的保存时间无关。

Objective To investigate the effect of preserved donor tarsal plate transplantation on the repair of the tarsus defect at the time of eye lid tumor removal. Methods Donor tarsal plates preserved in pure glycerin were used for the repair of tarsus defects of 58 cases after the complete removal of the eye lid tumors. The grafts were covered with rotated or slid myocutaneous and conjunctival flaps. The associations of the effect with the blood supply, with the size and the preserved time of the donor tarsal plates, as well as with the follow up time were analyzed by χ 2 test. Results Of the 43 cases whose plates were fully covered with conjunctival flaps, new blood vessels began growing into the donor tarsal plates one week after the operation. The grafts were vascularized one month later. The donor tarsal plates of 15 cases were only partly covered with conjunctival flaps. As a result, the grafts were vascularized in 2 3 months, and there was dissolution to varying degrees at the surface of the exposed parts of the plates. The effects of the 43 cases with good blood supply were significantly better than the effects of 15 cases with poor blood supply (χ 2=5 81, P <0 05). The sizes of the donor tarsal plates ranged from 5×10 mm 2 to 8×29 mm 2. Eleven cases were equal or shorter than half of the original sizes of donor tarsal plates, 34 cases were subtotal and 13 cases were total plates. The differences of the sizes led to different results (χ 2=6 28, P <0 05). The preserved times of donor tarsal plates were from 1 week to 2 5 years. However, the results were similar in all cases (χ 2 =0 99, P >0 05). All the patients were followed up for 6 months to 10 and half years (mean, 1 8 years). The effects had no statistical significance (χ 2=0 85, P >0 05). The cilia of the donor tarsal plates were preserved in 3 cases, but all of them were totally lost during post operative one month. After operation slight entropion occurred in 8 cases, slight ectropion in 3 cases, lagophthalmos for 2-3 mm in 7 cases, notch of the palpebral margin in 5 cases and thinness of the donor tarsal plates in 4 cases, but the functional and aesthetic results were normal. Thirty one cases were cured, 11 cases acquired tangible results and 12 cases were improved. The total effective rate was 93 1%. Conclusions The more blood supplies of the donor tarsal plates, the better the effects. So we must make all our efforts to improve the blood supplies of the donor tarsal plates. The effects were associated with the sizes of the plates, but not associated with the preserved times of the grafts and the follow up times. Preserved donor tarsal plate transplantation for the repair of tarsus defect is a relatively simpleoperation, the rejection is slight and the result satisfactory, thus it is an ideal plastic material.