羊膜建库及其临床应用研究

Study and Application of Reserving Human Amniotic Membrane

目的 :制备与保存羊膜 (Amnioticmembrane,AM ) ,为临床移植治疗眼表泪液 (Ocularsur face&Teardisease ,OSTD)提供新鲜羊膜 (Freshamnioticmembrane ,FSAM )、冻干羊膜 (Frozenam nioticmembrane ,FZAM )并观察其眼表重建的特点与临床疗效。方法 :采用目前国际公认的羊膜制备与保存方法 ,制备FSAM、FZAM并进行保存研究 ,经组织染色和电子显微镜检查 ,观察保存羊膜的形态及其活性 ;并将FSAM、FZAM应用于 12例OSTD患者 ,行患眼FSAM或FZAM移植术。通过术后印迹细胞学追踪观察移植后AM上皮细胞存活与移行、替代时间 ,评估AM移植重建眼表的临床疗效。结果 :FSAM、FZAM在光镜和电镜下均与正常球结膜组织结构相近 ,主要结构为胶原纤维和网状纤维。 12例OSTD患者行羊膜移植术 (Amnioticmembranetransplantation ,AMT)后均未见明显急性排斥反应 ,术后 1～ 2周可见少量新生血管长入植片 ,AMT后印迹细胞学追踪检查 ,术后 3个月为阴性 ,4个月出现阳性反应。所有患者术后随访 5～ 18个月 ,平均 11个月 ,AM在术后 4～ 9个月逐渐溶解、消失 ,移植区眼表的色泽与结构基本恢复正常。结论 :FSAM、FZAM是目前理想的结膜替代材料并可有效地用于重建角、结膜表面 ,减轻炎症反应 ,减少新生血管的生成 ,抑制纤维组织增生 。

Objective:To reserve human amniotic membrane (AM) and investigate the characteristics and application of fresh amniotic membrane (FSAM) or frozen amniotic membrane (FZAM) transplantation for ocular surface reconstruction.Methods Pieces of FSAM and FZAM were preserved by international recognized methods.To observe the configuration and vitality, all of them were photographed and examined by light microscope (LM), electron microscope (EM).and then the FSAM and FZAM were transplanted for Ocular surface & Tear disease (OSTD) in 12 cases. To evaluate the effect of transplantation for ocular surface reconstruction,impression cytology was examined with normal tear secretion post-operatively.Results:Both FSAM and FZAM are similar to conjunctival tissues- majority are collagen fibers and reticular fibers under the LM and EM. No acute rejection was observed after transplantation for OSTD in 12 cases. There were blood vessels growing into the graftes in the 1-2 th week. The impression cytology was shown on negative within 3 months, but positive in 4th month. All the patients were followed-up for 5-18 months (mean, 11 months), and AM was gradually progressive melt within 4-9 months. Each surgical eye's conjunctiva is transparent and normal.Conclusion:Both FSAM and FZAM are idea conjunctival succedaneum in the plastic surgery of conjunctiva. Amniotic membrane can be used as a graft to reconstruct ocular surface.Such transplantation can effectively reduce neovascularization, fibrosis, inflammation and recurrence. Our data indicated that complete removal of pathological tissues and perfect fixation of amniotic membrane graft are crucial steps in the reconstruction of ocular surface.