纤维蛋白胶治疗兔大的不规则角膜穿通伤

Treatment of large irregular rabbit corneal penetrating injury with fibrin glue

背景缝线缝合是目前标准的角膜穿通伤治疗方法，缝线缝合的缺点促使人们探索非缝合的手术方法，组织黏合剂是一种有前景的非缝合替代手术方法。 目的探讨用纤维蛋白胶治疗兔大的不规则角膜穿通伤的效果。 方法18只清洁级健康白色獭兔，按照随机数字表法分成缝合组和黏合组，用15°角膜穿刺刀在角膜非瞳孔区形成V字形、总长度为6 mm的角膜全层穿通伤，缝合组和黏合组分别用10-0缝线对位间断缝合3～5针或用纤维蛋白胶联合临时缝线和治疗性绷带角膜接触镜治疗，每只兔均以右眼为实验眼，左眼为自身对照。比较2个组手术时间，并对术后裂隙灯显微镜观察结果进行比较，分别于术后1、3、8周行角膜组织病理切片评估2个组伤口的愈合修复情况。 结果黏合组的平均手术时间为（3.48±0.48）min，显著低于缝合组的（7.77±1.30）min，差异有统计学意义（t＝9.28，P〈0.01）。术后裂隙灯显微镜观察发现，黏合组伤口愈合快且平整。角膜组织病理学检查发现，黏合组伤口愈合规则，炎症反应轻，无新生血管形成；而缝合组纤维排列不整齐，缝线周围有大量炎性细胞及巨噬细胞浸润，炎症反应较重，术后3周发现有新生血管形成。 结论与传统缝线相比，采用纤维蛋白胶联合临时缝线和治疗性绷带角膜接触镜的方法治疗兔大的不规则角膜穿通伤具有操作简单、手术时间短、术后刺激小、炎症反应轻、愈合时间短、伤口愈合规则、无新生血管形成的优点。

BackgroundSuture stitching is currently the standard treatment for corneal penetrating injuries.The shortcomings of suture stitching have led to the exploration of non-sutured surgical methods.Tissue adhesive is a promising non-suture replacement procedure. ObjectiveThis study was to observe the effect of fibrin glue on large irregular rabbit corneal penetrating injury. MethodsEighteen pure white healthy rabbits were randomly divided into suture group and adhesive group.A total length of 6-mm non-self-sealing corneal penetrating injury in non-pupillary-area of the right eye formed with a 15° corneal puncture knife was repaired with fibrin glue plus temporary suture and therapeutic corneal contact lens （9 eyes） or with 3 to 5 interrupted 10-0 nylon sutures （9 eyes） with the fellow eyes acted as the internal controls respectively.Operative time was compared between the two groups.Clinic observation was performed with slit lamp microscope.Animals were humanely sacrificed for histologic examination at week 1, 3, and 8 to evaluate wound healing. ResultsThe average operation time was （3.48±0.48） minutes in the adhesive group, which was significantly lower than that in the suture group （[7.77 ± 1.30]minutes） （t=9.28, P〈0.01）. The postoperative slit lamp microscope observation indicated corneal wounds were quickly and regularly healed in the glued corneas compared with the stitched ones.The histologic examination revealed that glued corneas had regular healing, mild inflammation, and no corneal neovascularization, while sutured corneas showed irregular fibrin arrays, a large number of inflammatory cells and macrophages infiltration around the suture, heavy inflammatory response.Neovascularization was found at week 3 postoperatively. ConclusionsFibrin glue combined with temporary suture and therapeutic corneal contact lens is an effective treatment in sealing large irregular corneal wounds with considerable advantages over traditional sutures, including simplified operative technique, short surgery time, less postoperative irritation, mild inflammation, more regular wound healing, short healing time, and no corneal neovascularization.