自体血管化颌下腺移植治疗角结膜干燥症

Treatment of xerophthalmia by transplantation of autologous vascularized submandibular gland

目的 研究自体血管化颌下腺移植治疗角结膜干燥症的可行性。方法 对 19例重症角结膜干燥症患者 ,采用显微外科技术 ,将自身颌下腺摘除后 ,移植到颞部 ,颌下腺的动静脉分别与颞浅动静脉吻合 ,颌下腺导管转移至眼穹隆部。以颌下腺分泌液代替泪液。结果 19例中目前 15例移植成功 ,4例因静脉栓塞 ,腺体未能成活。移植成功的患者 ,观察 3月至 2年 ,角结膜干燥症状消失 ,畏光怕风症状减轻 ,可停用人工泪液。 4例出现泪溢 ,行移植腺体部分切除后得到矫正。 1例导管口闭锁 ,行导管重建后后复通。结论 自体血管化颌下腺移植是重症角结膜干燥症行之有效的治疗方法。

Objective To investigate the feasiblity of treatment of xerophthalmia by transplantation of autologous vascularized submandibular gland (SMG). Methods The SMGs of 19 patients with severe keratoconjunctivitis were transfered to their temporal region by microsurgery. The arteries and veins of the SMGs were anastomosed to the super temporal arteries and veins, the SMG ducts were implanted into the conjunctival fornix of the eye. The saliva secreted by the SMG was used as the substitute of tear. Results The tranplantation succeded in 14 patients and failed in 4. Follow up lastred for 3 months to 2 years. The symptom of corneal xerosis disappeared, the symptoms of photophobia and anemophobia were alleviated, and artificial tear substitutes were not used any more. Epiphora appeared in 4 cases and diasppeared after partial resection of the transplanted galnd. Atresia of orifice occurred in one case and was cured by reconstruction of the duct. Conclusion Transplantation of autologous vascularized SMG is effective in treating severe keratoconjunctivitis sicca.