深低温保存异体睑板睑结膜移植修复眼睑缺损的临床观察

目的 评价深低温保存异体睑板睑结膜移植修复,因眼睑肿物切除造成的眼睑缺损的临床效果.方法 采用深低温保存异体睑板睑结膜移植眼睑再造术修复眼睑缺损21例(21只眼).结果 术后随访3～80月,平均46.9月.本组病例共治愈10只眼,好转11只眼,1例(1只眼)因首次手术时切缘未净再次行扩大切除时未更换移植片导致植片脱落.结论 深低温保存异体睑板睑结膜移植修复眼睑缺损,简便易行,保存方便,术后并发症少,临床效果满意.异体睑板睑结膜是理想的眼睑缺损修复的材料.     

用易位睑板结膜瓣修复眼睑缺损

用易位睑板结膜瓣修复眼睑缺损郑州市第二人民医院眼科孙芳利用上睑或下睑缺损区以外残存的睑板睑结膜，设计成易位睑板结膜瓣１期修复全层部分睑缺损１０例１２只眼，取得了满意的效果。重建了眼睑功能。达到术后外形的美观。材料及方法一般材料１０例１２只眼，男８例，...     

兔异体睑板睑结膜移植修复眼睑缺损实验研究

目的比较甘油、酒精及深低温3种方法保存兔异体睑板修复眼睑缺损的有效性和术后组织病理学反应及细胞凋亡情况。方法分3组进行甘油、酒精及深低温保存兔异体睑板睑结膜移植修复眼睑缺损各16眼,术后1周、1月及3月分别取材用光镜观察植片的组织病理学改变,并以原位末端标记（TUNEL）技术观察移植后细胞凋亡情况。结果3组术后均有不同程度的炎性反应出现,深低温保存兔异体睑板移植术后临床及组织病理学观察炎性反应轻于甘油及酒精保存材料移植后反应;3组均出现细胞凋亡现象,深低温组移植术后凋亡细胞数量较甘油、酒精组少。结论深低温保存的兔异体睑板移植修复眼睑缺损活性高,简便易行,保存方便,术后并发症少,排斥反应小,是理想的眼睑缺损修复的材料。     

睑板腺癌术后眼睑缺损的整复

目的探讨睑板腺癌术后眼睑缺损的整复方法。方法睑板腺癌6例。1例上睑肿物切除后上睑缺损小于1/4,创缘直接分层缝合;1例上睑肿物切除后上睑缺损大于1/2,但未侵及睑板上缘,残留睑板结膜瓣向下滑行修复缺损;2例肿物侵及睑板上缘,切除后缺损分别大于1/2和3/4,下睑板结膜滑行修复上睑缘,上睑提肌瓣向下滑行和滑行睑板吻合;1例下睑肿物切除后缺损大于3/4,鼻颊部皮瓣转移修复;1例部分眶内容摘除植皮修复。结果术后随访观察12～19个月,1例眶内容摘除眶内皮片成活良好,其余5例眼睑外形及功能均恢复,眼睑闭合好,活动自如。结论睑板腺癌切除术后根据眼睑缺损的部位和大小选择不同的修复方案,均取得了良好的效果。     

对位睑板结膜瓣滑行修复眼睑缺损

目的：评价对位睑板结膜瓣滑行修复眼瞪缺损的效果。方法：对41例眼瞪全层缺损患者,其中上睑10例,下睑31例,切除肿瘤导致缺损者33例。外伤导致缺损者8例,缺损范围在1/3-2/3,年龄24-79岁,采用与缺损眼睑相对应的眼睑睑板结膜瓣滑行至缺损区来修补眼睑缺损。结果：术后随访31例,随访时间3月-5年,除缺损外,1例出现轻度上睑退缩（退缩量为1-2mm),1例出现轻度下睑外翻,余眼睑外形及功能均基本恢复,眼睑活动自如,闭合完全,无严重并发症发生,结论：对位睑板结膜瓣滑行可用于修复眼睑后层缺损,且不受有无睑板替代物的限制。不需另添手术创口,可更好地恢复眼睑的功能及外观。     

异体睑板移植修复眼睑缺损

目的 修复21眼因各种原因所致的部分或全层眼睑缺损。方法 采用低温保存的异体睑板移植替代瞪板,内层行结膜转移或唇粘膜移植。外层应用邻近带蒂皮瓣或游离显效5眼,改善2眼,失败1眼,术后效果与血运 的好坏和移植片的大小有关。结论 采用低温保存的异体睑板修复眼睑缺损,排斥反应轻,疗效佳。是替代睑板的理想材料。     

Medpor薄片替代睑板植入 修复眼睑缺损观察

目的 观察人工合成材料Medpor薄片替代睑板植入,在修复眼睑缺损中的应用效果.方法 采用美国产9546型Medpor薄片替代睑板联合滑行结膜瓣和带蒂皮瓣移植修复眼睑缺损,共10例患者(10只眼),随访6个月至5年.结果 术后眼睑形态及功能,无收缩性上睑内卷、睑内外翻、倒睫等合并症.植人物无吸收、移位、排斥,1例植人物暴露感染取出.结论 Medpor薄片具有良好的组织相容性及形态稳定性,易于修剪和塑形,是一种理想的睑板替代物.     

Medpor薄片替代睑板植人修复眼睑缺损观察

目的 观察人工合成材料Medpor薄片替代睑板植入,在修复眼睑缺损中的应用效果.方法 采用美国产9546型Medpor薄片替代睑板联合滑行结膜瓣和带蒂皮瓣移植修复眼睑缺损,共10例患者(10只眼),随访6个月至5年.结果 术后眼睑形态及功能,无收缩性上睑内卷、睑内外翻、倒睫等合并症.植人物无吸收、移位、排斥,1例植人物暴露感染取出.结论 Medpor薄片具有良好的组织相容性及形态稳定性,易于修剪和塑形,是一种理想的睑板替代物.     

用异体巩膜代替睑板行眼睑再造术

眼睑恶性肿瘤由于切除范围大，造成眼睑缺损大，故修复时需用不同的方式，使眼睑恢复原形，并保持其功能。作者遇三例，经手术取得较满意的效果，报告如下：一般资料：本文所报道的3例眼睑肿瘤均发生在下睑，男2例，女1例，2例为睑板腺癌，1例为基底细胞癌，其中1例范围较大，侵及整个下睑板，我们采用手术切除肿瘤，并在术中作冰冻切片，冰冻切片阴性后，再用异体巩膜代替下睑睑板作修复手术。术中切缘送冰冻切片尤为重要，它既能确定肿瘤已彻底切除，又不至于过多的切除正常的眼睑组织。材料与方法1．巩膜片保存：取自于异体眼球摘除术后…     

异体巩膜移植治疗眼睑恶性肿瘤术后睑板缺损的临床观察

目的：探讨异体巩膜移植在眼睑恶性肿瘤切除术后睑板缺损重建手术中的临床效果。

方法：对24例24眼眼睑恶性肿瘤术后睑板缺损长度大于1/2睑板的患者实施眼睑重建, 利用异体巩膜替代睑板,异体巩膜材料取自眼库。

结果：术后3～12mo随访,眼睑重建术后形态良好,未出现明显的异体巩膜溶解或排斥反应; 巩膜脉络膜面均被结膜细胞移行覆盖,异体巩膜与皮肤粘连紧密,缺损区修复完整。4眼出现睑缘轻、中度内翻后行眼睑内翻矫正。2眼出现不同程度睑球粘连,行睑球粘连分离手术。

结论：异体巩膜具有材质稳定性好、组织相容性佳、取材保存方便、手术操作简单易行等优点。术后眼睑功能良好、外观满意,是理想的睑板替代材料。     

Sliding tarsal flap for reconstruction of large, shallow lower eyelid tarsal defects

PURPOSE: To describe a novel technique for reconstructing shallow, full-thickness defects of the lower eyelid. METHODS: Twelve patients with shallow, full-thickness lower eyelid defects after Mohs excision of eyelid malignancies were treated with this technique. The posterior lamella was reconstructed by obliquely incising the residual tarsus to create medial and lateral tarsal flaps. These flaps were obliquely overlapped to tighten the eyelid and reconstruct a tarsus approximating normal height. The anterior lamella defect was then reconstructed by using local flaps or free grafts in a conventional manner. RESULTS: Eyelid defects ranged from 25 to 40 mm horizontally and 20 to 35 mm vertically, with tarsal defects ranging from 18 to 27 mm horizontally and 2 to 3.5 mm vertically. A stable eyelid margin with good aesthetic appearance was achieved in all patients. Two patients had mild eyelid retraction not requiring intervention, and one had lower eyelid entropion 9 months after surgery. CONCLUSIONS: Sliding tarsal flaps are an effective technique for reconstruction of this type of defect. The advantages of this approach are its simplicity, utilization of preserved tissue, and avoidance of the morbidity associated with more complex procedures.     

新鲜和保存羊膜移植重建结膜眼表的临床对比研究

目的：比较新鲜羊膜和保存羊膜治疗睑球粘连的疗效差异，分析影响疗效的因素。方法：共51例55只眼因陈旧性化学伤、热烧伤或Stevens—Johnson综合征而发生睑球粘连的临床连续病例接受睑球粘连分离联合新鲜羊膜移植（22只眼）或保存羊膜移植（33只眼）。其中男30例32只眼．女21例23只眼。年龄4～51岁．平均（34．2±4.3）岁。其中11只眼在烧伤后5～11个月，平均（7．4±1．6）个月时接受手术，40只眼在烧伤后1～8年，平均（2．0±0．7）年进行手术。结果：术后随访12-32个月，平均（19．3±4．1）个月。所有移植存结膜眼表面的羊膜（包括新鲜羊膜）植片在术后早期均未见溃烂和溶解，周边对合良好。31／55（56．4％）只眼形成了足够深的穹窿部且恢复了眼球运动功能。9／55（16．4％）只眼发生部分睑球粘连，眼球运动轻度受限，但其面积远较术前为小。15／55（27.3％）眼术后发生中度以上的睑球粘连。新鲜羊膜和保存羊膜重建眼结膜表面的效果相似（X2=0．466，P=0．797）；不同程度睑球粘连的患者其羊膜移植术后的效果不同（新鲜羊膜．X2=27．995，P=0．000；保存羊膜，X2=33．610，P=0．000）；在眼表烧伤后1年内手术比1年以上进行羊膜移植的效果也不同（X2=4、243，P=0．039）。结论：新鲜羊膜和保存羊膜一样可以有效地用于重建睑球粘连解除后的结膜眼表。患眼术前睑球粘连程度以及烧伤后其眼表炎症是否处于安静状态等因素都会直接影响羊膜移植重建眼结膜表面的远期疗效。     

Irradiated homologous tarsal plate banking: a new alternative in eyelid reconstruction. Part I. Technique and animal research

Reconstruction of full thickness eyelid defects requires the correction of both posterior lamella (tarsus, conjunctiva) and anterior lamella (skin, muscle). Tarsal substitutes including banked sclera, nasal cartilage, ear cartilage, and periosteum can be beneficial for posterior lamellar repair, while anterior lamellar replacement, including skin grafts, pedicle flaps, advancement flaps, etc., is important to cover the posterior reconstructed portion. At times, due to extensive tissue loss, the eyelid reconstruction can be particularly challenging. We have found an alternative posterior lamellar reconstructive technique utilizing irradiated homologous tarsal plate that can be particularly useful in selected cases of severe tissue loss. The experimental surgical procedure in monkeys and the histological fate of the implanted tarsus is described in Part I, and followed in Part II by our experience with this tissue in six human patients.     

Amniotic membrane transplantation in entropion surgery.

PURPOSE: To evaluate the role of amniotic membrane transplantation in the management of cicatricial eyelid entropion. DESIGN: Prospective, noncomparative interventional case series. PARTICIPANTS: Eighteen consecutive patients with cicatricial entropion. METHODS: A gray line lid split procedure with vertical anterior lamella repositioning was performed on 25 eyelids (upper or lower) of 18 patients with moderate to severe cicatricial entropion. Preserved human amniotic membrane (AM) was used to cover the bare tarsus up to the lid margin and secured with running 7-0 Vicryl. Impression cytology of the AM was performed at various stages postoperatively to study the epithelialization process. MAIN OUTCOME MEASURES: (1) Reepithelialization of bare tarsus, (2) extent of tarsal shrinkage, (3) recurrence of entropion. RESULTS: All the AM grafts took well. The most common complication was hemorrhage below the graft, which occurred in six cases. Complete success with no lashes touching the globe was achieved in 22 of 25 (88%) lids after a minimum follow-up of 12.0 months. The mean follow-up was 17.8 months. Two cases (qualified success) had recurrent trichiasis treated successfully with electrolysis. One case with severe trachomatous upper lid entropion recurred 14 months after surgery. The AM accelerated the epithelialization of bare tarsus; this was demonstrated by lack of fluorescein staining and reversion to skin color within 2 to 3 weeks. However, AM could not prevent tarsal shrinkage. Impression cytology demonstrated that features of conjunctival epithelium were present for the first postoperative month, but this was gradually replaced by squamous metaplasia, with keratinization appearing as early as 3 weeks postoperatively. CONCLUSIONS: The use of AM in a lid split procedure for correction of cicatricial entropion helps the bare tarsus epithelialize rapidly and improves the initial cosmetic result of surgery.     

The use of tarsus as a free autogenous graft in eyelid surgery

This is a report of the use of autogenous tarsus as a free graft in 121 eyelid surgical procedures. Seventy-three operations were for reconstruction of full-thickness defects and 30 were for repair of eyelid retraction. The remainder were for repair of cicatricial entropion, symblepharon, distichiasis, and irregularity of the eyelid margin. No grafts failed. There were three complications to a donor eyelid. It is believed that donor eyelid complications are less likely when the graft is harvested so as to include the upper tarsal margin. The free autogenous tarsal graft was found to be effective in repairing a variety of eyelid defects.     

表浅肌肉腱膜皮瓣联合硬腭黏膜移植修复全层眼睑缺损

目的探讨利用眼周表浅肌肉腱膜系统（SMAS）皮瓣联合硬腭黏膜移植修复中、重度全层眼睑缺损的临床疗效。方法对26例（26只眼）大于或等于眼睑全长1／2的全层眼睑缺损患者,采用硬腭黏膜移植替代眼睑后层,即睑板和睑结膜层;利用眼周血供丰富的SMAS皮瓣修复眼睑前层,即皮肤肌肉层。其中5例采用眼轮匝肌蒂皮瓣,5例为颞浅动脉皮瓣,7例为眉上皮瓣,9例为上睑皮肤轮匝肌双蒂瓣。手术操作中首先行硬腭黏膜移植,然后根据眼睑前层缺损的部位和范围设计眼周的SMAS转位皮瓣,术毕行睑缘缝合3个月。结果全部患者随访6～36个月,平均11个月。转位皮瓣全部成活,硬腭黏膜植片成活好,无收缩,眼睑外观及功能改善较满意。结论眼周SMAS皮瓣联合硬腭黏膜移植可一次性修复缺损的眼睑全层,效果肯定。     

硬腭黏膜移植联合眶周表浅肌肉腱膜系统皮瓣重建全层眼睑缺损

目的:探讨利用自体游离硬腭黏膜植片替代后睑组织联合眶周表浅肌肉腱膜系统(SMAS)皮瓣转移修复缺损的前层眼睑皮肤,重建因肿瘤术后或外伤所致的全层眼睑缺损的临床疗效。方法:对16例≥眼睑全长1/2中重度全层眼睑缺损患者,全部用口腔硬腭黏膜植片替代睑板和结膜,再造后层眼睑;用眶周血供丰富的表浅肌肉腱膜系统(SMAS)皮瓣转移覆盖于硬腭黏膜上,替代缺损的眼睑皮肤肌肉层再造前层眼睑,其中10例采用眼轮匝肌单蒂皮瓣,3例为颞浅动脉皮瓣,2例为上睑皮肤轮匝肌双蒂皮瓣,1例为眉上皮瓣。手术操作中首先行硬腭黏膜移植,然后根据眼睑前层缺损的部位和范围设计眶周的SMAS转移皮瓣,手术完毕行睑缘缝合3～6mo后切开。结果:全部患者随访>12mo,硬腭黏膜植片及其转移皮瓣全部成活,无移位、感染和坏死等不良反应,无收缩,眼睑外观及功能改善满意。结论:硬腭黏膜联合SMAS皮瓣转移修复重建眼睑全层缺损,可以一次性修复眼睑缺损的皮肤、睑板、结膜,疗效肯定,具有较高的临床应用价值。