同种异体脱细胞真皮用于羟基磷灰石眼台覆材料的临床观察

目的比较同种异体脱细胞真皮与同种异体巩膜作为眼球摘除并羟基磷灰石(HA)义眼台植入的覆盖材料术后效果,探讨同种异体脱细胞真皮的临床应用价值。设计回顾性病例系列。研究对象北京同仁医院2003年5月至2005年3月收治的眼球萎缩患者行眼球摘除并HA眼台植入手术患者112例。方法临床观察112例112眼,眼球摘除并HA眼台植入覆盖同种异体巩膜者为异体巩膜组(56眼),覆盖同种脱细胞真皮者为脱细胞真皮组(56眼)。两组在手术后1天、3天、1周、1个月及6个月进行随诊,严密观察结膜伤口愈合情况及有无HA眼台的暴露。主要指标结膜伤口愈合情况、HA眼台暴露情况。结果异体巩膜组中有1眼结膜伤口裂开但无HA眼台暴露。脱细胞真皮组中5眼术后结膜伤口裂开,其中2眼HA眼台暴露。经再次手术治疗后痊愈,但与异体巩膜组比较两组差异无统计学意义。两组均无其他手术并发症出现。结论同种异体脱细胞真皮作为HA眼台的覆盖材料应用于临床其价值得到初步肯定,与同种异体巩膜相同,无术后严重并发症。不易作为传染源的载体及容易获得为其优点,应用这种材料需手术操作更为细心及熟练。(眼科,2007,16:378-381)

Clinical observation of using homologous acellular dermal matrix as wrapping material in the orbital implantation surgery

Objective To evaluate the efficiency of using homologous acellular dermal matrix instead of homologous sclera as wrapping materials for orbital implantation surgery.Design Retrospective case series.Participants From May 2003 to Mar 2005,One hundred and twelve patients with primary enueleation and HA implantation were enrolled.Methods Clinical observation of comparative case series,112 eyes from 112 consecutive patients were included and allocated for primary enucleation and either homologous acellular dermal matrix-wrapped hydroxyapatite(AHA)orbital implant(56 cases,50%)or sclera-wrapped hydroxyapatite(SHA)orbital implant (56 cases,50%)under general anesthesia,in order to compare conveniently,the same number cases in either series was selected.Com- plete socket examination was performed at Iday,3 days,1 week,1 month and 6 months after surgery.Main Outcome Measures Sock- et examination,hydroxyapatite implant exposure.Results One patient in the SHA group had a split in conjunctiva but no HA exposure. Five patients in AHA group had complications about split in eonjunetiva after operation and 2 of them with HA exposure.But there was no significance in statistics between the two groups.Conclusions Homologous acellular dermal matrix can be used as a new kind of material as wrapping material for hydroxapatite orbital implant.It can not be a carrier of virus and easy obtained.But the operation must be taken carefully.(Ophthalmol CHN,2007,16:378-381)