唾液腺移植手术对严重干眼的治疗研究进展

Update on salivary gland transplantation in severe dry eye

作为一种多因素引起的慢性眼表疾病,干眼的治疗应根据病因和严重程度进行长期和个体化设计。对于泪腺分泌功能丧失,常规药物治疗及物理治疗效果不佳且有可能导致视力严重受损的严重干眼患者,若其唾液腺并未遭受严重破坏,自体唾液腺移植手术可为这部分患者带来希望。据文献报道,三大唾液腺及小唾液腺都被尝试过用作移植物,其中下颌下腺移植后不仅有较高的腺体成活率,还可保持分泌活性,在随访期间(长达180个月)有效改善干眼所致的眼部干涩、异物感等主观症状及视力、泪膜破裂时间等干眼相关客观指标,因此成功作为泪腺替代物。众多小唾液腺中,唇腺被证明能够在移植术后随访期间(文献报道最长达10年)维持足够润滑眼表的分泌功能,因此成为了一种可选择的泪腺替代物,近年来唇腺移植术相关技术取得了新进展。本文就近年来对三大唾液腺(腮腺、下颌下腺和舌下腺)和小唾液腺(唇腺应用最多)移植手术的适应证、技术、临床实践评价、腺体术后分泌的药物调控及并发症等方面的研究进展进行综述。

As a chronic eye disease caused by multiple factors,the treatment of dry eye disease(DED)should be individualized according to the cause and severity of the disease.In patients with severe DED who have lost lacrimal secretion but have not suffered severe damage to the salivary glands,autologous salivary gland transplantation may help bring hope to these patients if conventional treatments are not effective enough.According to the literature,the three major salivary glands and the minor salivary glands have been used as lacrimal gland replacements.Studies have shown that submandibular glands not only have a high gland survival rate after transplantation,but also maintain secretory activity after transplantation and therefore successfully serve as lacrimal gland replacement.During the up to 180-month follow-up period,the subjective symptoms and signs of DED such as dryness,foreign body sensation,and other objective indicators related to DED such as visual acuity and tear film break-up time are effectively improved.Among the minor salivary glands,the labial glands have been proven to maintain secretory function during the up to ten-year follow-up period after transplantation according to the literature,and have therefore become an alternative lacrimal gland replacement.This review summarized the indications,surgical techniques,efficacy evaluation,modulation of salivary flow and complications of the surgery,involving three major salivary glands,parotid,submandibular and sublingual glands,and minor salivary glands among which labial glands are most commonly used.