羊膜泪道修复支架对兔泪小管损伤后愈合过程的影响

Effects of amniotic membrane lacrimal duct repair stent on healing process of rabbit canaliculi injury

目的探讨羊膜泪道修复支架对兔泪小管损伤后愈合过程的影响。方法选择新西兰大白兔40只(80眼),其中31只兔制作兔泪小管损伤模型,4只造模失败,将造模成功的27只兔(54眼)随机分为3组,泪道羊膜组(A组):将兔双侧泪小管进行羊膜泪道修复支架植入;硅胶组(B组):进行双侧泪小管兔泪道硅胶支架植入;造模组(C组):造模后不作任何处理。剩余9只正常兔作为空白对照,分别于术后1周、2周、4周三个不同时间点观察兔泪小管的组织学变化情况。结果术后3组均可见兔泪小管组织上皮层细胞数量不同程度减少,伴大量炎症细胞浸润,3组各时间点炎症细胞数比较,A组<B组<C组,以术后4周最为明显,A组(3.0±1.7)个、B组(8.0±2.5)个、C组(10.0±3.6)个,3组间两两比较差异均有统计学意义(均为P<0.05)。正常兔泪小管组织中黏蛋白Muc5AC表达阴性;术后3组间各时间点比较,α-平滑肌蛋白的积分光密度值差异均有统计学意义(均为P<0.05)。结论兔泪小管上皮缺乏杯状细胞,羊膜作为泪道生物性的修复支架材料,能减轻炎症反应程度和抑制受损兔泪小管的基质纤维化水平,用于重建修复受损泪道黏膜及抑制泪道瘢痕性狭窄具有较大的潜力。

Objective To study the effects of amniotic membrane lacrimal duct repair stent on the healing process of rabbit canaliculi injury. Methods A total of 40 healthy adult New Zealand rabbits（80 eyes） were chosen, and in which 31 cases were chosen to establish the canaliculi injury model. Totally 27 canaliculi injured rabbits（54 eyes） were divid- ed into three groups ：amniotic membrane group （group A, amniotic mem- brane lacrimal duct repair stent insertion ）, silicone intubation group （group B, silicone intubation insertion）, positive control group （group C, no material insertion） ,negative control group（ group D ,normal rabbits）. The rabbit canaliculies were removed at postoperative 1 week, 2 weeks and 4 weeks, and the pathological changes were observed. Results After operation, the amount of canaliculi epitheliμm became deficient, epi- thelial cells were edema and disarray, nμmerous inflammatory cells infil- trated the canaliculi tissue at different levels in three groups. The inflammatory cells in the canaliculi of group C were significantly higher than those in group A and group B, and group B were higher than group A at postoperative different time, especially at 4 weeks, the amounts of inflam- matory cells in group A were 3.0 -＋ 1.7, group B were 8.0 -＋ 2.5, and group C were 10.0 _＋ 3.6. MucSAC expression in normal canaliculi epithe- liμm was negative, there were statistical differences in mean optical den- sity values of a-smooth muscle actin expression at postoperative different time among three groups. Conclusion The rabbit canaliculi epithelial goblet cell is deficient. As the repair material for canaUculi injury, amniot- ic membrane lacrimal duct repair stent can relieve the inflammation, in- hibit the fibrous tissue proliferation, which can be used to repair the canaliculi mucous membrane and inhibit the canaliculi scared stenosis.