颌下腺移植治疗角结膜干燥症的手术要点及并发症处理

Microvascular submandibular gland transfer for severe keratoconjunctivitis sicca: operation key points, prevention and management of complications

目的 总结血管化自体颌下腺移植治疗重症角结膜干燥症的手术要点及并发症预防与处理的经验。方法 用该技术治疗 2 3例重症角结膜干燥症 ,术后行99m锝核素显像 ,随诊及并发症相应处理。结果 1 9例腺体移植成功 ,眼干症状消失 ,停用人工泪液 ;4例腺体未成活 ;5例出现泪溢 ,经切除部分移植腺体后症状消失 ;1例颌下腺导管闭锁 ,行导管重建术后症状减轻。结论 静脉桥接可解决腺体静脉与颞浅静脉管径不匹配问题 ;断离腺体前 ,保留颌外动脉 ,观察 3条静脉渗血情况及游离颌下腺行颌外动脉肝素生理盐水灌注 ,观察 3条静脉渗出情况 ,有助于选择合适的供体静脉。恰当处理与颌下腺移植治疗重症角结膜干燥症手术相关的各个环节 。

Objective To summarize operation key points, prevention and management of complications in vascularized autotransplantation of submandibular gland for treatment of severe keratoconjunctivitis sicca. Methods 23 patients with severe keratoconjunctivitis sicca were treated by this procedure. Postoperative 99m Tc images, follow up studies, and management of complications were performed. Results The transplantations were successful in 19 cases, whose symptoms of xerophthalmia disappeared. The patients could stop applying artificial tears. In 4 patients the transplanted glands did not survive. Epiphora occurred in 5 cases. They were successfully treated by reducing the size of the graft. Obstruction of the Wharton′s duct took place in one case and was treated by reconstructing the duct.When the superficial temporal vein was too small,venous bridging was applied. To select a relevant vein for anastomosis ,blood oozing from the three veins was carefully inspected prior cutting off the gland when the external maxillary artery was preserved and was infused with heparin after the gland had been freed. Conclusions If every point has been properly managed, the successful rate of operation could be warranted.