羊膜移植眼表重建术的护理

采用新鲜或保存７２ｈ的健康羊膜移植治疗严重眼表闰患６例（６只眼）。术后随访３个月，结果：６例均未出现羊膜植片排斥反应，无感染、溶解、脱落等７并发症，植片生长良好，无染色，眼外观改善，视力不同程度提高，眼表重建成功。提出术前加强心理及健康指导，术后观察植片生长、角膜创而愈合情况，预防植片感染，保护眼部，防止植片撕掊及做好出院指导是保证眼表重建成功的关键。     

羊膜遮盖治疗轻中度急性眼表烧伤的显微手术技巧

目的 探讨羊膜遮盖治疗急性轻、中度眼表烧伤的临床价值及其显微手术技术.方法 将Ⅱ～Ⅲ度角膜烧伤、伴或不伴部分角膜缘Ⅳ度烧伤的病例分别接受羊膜遮盖术(21眼)或药物治疗(13眼).对4例在羊膜部分溶解、眼表面已经上皮化时取下羊膜进行透射电镜检查.结果 羊膜在遮盖术后5～10[平均(11±2)d]局部溶解和脱落.羊膜溶解后暴露的角膜很快上皮化.角膜缘破坏＞1/2周的患眼在角膜缘的坏死侧出现少量新生血管或有菲薄的新生纤维血管膜侵入角膜.术后视力提高1至6行,平均(3.3±1.2)行.电镜结果显示:羊膜植片溶解,浸润的多形核细胞较少且发生大比例凋亡.药物治疗组4/13眼角膜表面进行性溶解,其后进行了板层角膜移植手术;其他眼发生不同程度的睑球粘连和角膜表面大量假性胬肉.结论 羊膜遮盖可以减少轻、中度角膜急性烧伤期的炎症反应和角膜深层新生血管形成,阻止眼表的进行性溃烂和融解,甚至还可促进角膜缘功能的恢复.     

双层羊膜移植治疗蚕蚀性角膜溃疡的显微技术探讨

目的 探讨双层羊膜移植术治疗蚕蚀性角膜溃疡的显微手术要领及临床疗效.方法 对经药物及(或)板层角膜移植术治疗无效或复发的蚕蚀性角膜溃疡6例(6眼),行双层羊膜移植术,观察术后角膜上皮及溃疡的愈合、基质水肿消退、新生血管萎缩、内外层羊膜转归及复发等情况.结果 随访24～34个月.外层羊膜多于术后7～11 d自溶吸收或脱落,予以拆线.7～15 d角膜上皮愈合,2～3周角膜基质水肿基本消退,2～3个月溃疡区新生血管逐渐萎缩,术后3个月内层羊膜与溃疡面牢固愈合,5～8个月病变区角膜渐呈半透明.随诊期内,4眼眼表稳定,未复发;另2眼因缝线暴露、未及时随诊拆线于术后12～13个月复发,再行板层角膜移植术,未再复发.结论 双层羊膜移植术在蚕蚀性角膜溃疡的治疗中具有很好的优势,显微手术技巧的掌握及严格复诊拆线是手术成功的关键,也为进一步角膜移植术的进行提供良好条件.     

双层羊膜移植治疗蚕蚀性角膜溃疡的显微技术探讨

目的 探讨双层羊膜移植术治疗蚕蚀性角膜溃疡的显微手术要领及临床疗效.方法 对经药物及(或)板层角膜移植术治疗无效或复发的蚕蚀性角膜溃疡6例(6眼),行双层羊膜移植术,观察术后角膜上皮及溃疡的愈合、基质水肿消退、新生血管萎缩、内外层羊膜转归及复发等情况.结果 随访24～34个月.外层羊膜多于术后7～11 d自溶吸收或脱落,予以拆线.7～15 d角膜上皮愈合,2～3周角膜基质水肿基本消退,2～3个月溃疡区新生血管逐渐萎缩,术后3个月内层羊膜与溃疡面牢固愈合,5～8个月病变区角膜渐呈半透明.随诊期内,4眼眼表稳定,未复发;另2眼因缝线暴露、未及时随诊拆线于术后12～13个月复发,再行板层角膜移植术,未再复发.结论 双层羊膜移植术在蚕蚀性角膜溃疡的治疗中具有很好的优势,显微手术技巧的掌握及严格复诊拆线是手术成功的关键,也为进一步角膜移植术的进行提供良好条件.     

双层羊膜移植治疗蚕蚀性角膜溃疡的显微技术探讨

目的 探讨双层羊膜移植术治疗蚕蚀性角膜溃疡的显微手术要领及临床疗效.方法 对经药物及(或)板层角膜移植术治疗无效或复发的蚕蚀性角膜溃疡6例(6眼),行双层羊膜移植术,观察术后角膜上皮及溃疡的愈合、基质水肿消退、新生血管萎缩、内外层羊膜转归及复发等情况.结果 随访24～34个月.外层羊膜多于术后7～11 d自溶吸收或脱落,予以拆线.7～15 d角膜上皮愈合,2～3周角膜基质水肿基本消退,2～3个月溃疡区新生血管逐渐萎缩,术后3个月内层羊膜与溃疡面牢固愈合,5～8个月病变区角膜渐呈半透明.随诊期内,4眼眼表稳定,未复发;另2眼因缝线暴露、未及时随诊拆线于术后12～13个月复发,再行板层角膜移植术,未再复发.结论 双层羊膜移植术在蚕蚀性角膜溃疡的治疗中具有很好的优势,显微手术技巧的掌握及严格复诊拆线是手术成功的关键,也为进一步角膜移植术的进行提供良好条件.     

双层羊膜移植治疗蚕蚀性角膜溃疡的显微技术探讨

目的 探讨双层羊膜移植术治疗蚕蚀性角膜溃疡的显微手术要领及临床疗效.方法 对经药物及(或)板层角膜移植术治疗无效或复发的蚕蚀性角膜溃疡6例(6眼),行双层羊膜移植术,观察术后角膜上皮及溃疡的愈合、基质水肿消退、新生血管萎缩、内外层羊膜转归及复发等情况.结果 随访24～34个月.外层羊膜多于术后7～11 d自溶吸收或脱落,予以拆线.7～15 d角膜上皮愈合,2～3周角膜基质水肿基本消退,2～3个月溃疡区新生血管逐渐萎缩,术后3个月内层羊膜与溃疡面牢固愈合,5～8个月病变区角膜渐呈半透明.随诊期内,4眼眼表稳定,未复发;另2眼因缝线暴露、未及时随诊拆线于术后12～13个月复发,再行板层角膜移植术,未再复发.结论 双层羊膜移植术在蚕蚀性角膜溃疡的治疗中具有很好的优势,显微手术技巧的掌握及严格复诊拆线是手术成功的关键,也为进一步角膜移植术的进行提供良好条件.     

双层羊膜移植治疗蚕蚀性角膜溃疡的显微技术探讨

目的 探讨双层羊膜移植术治疗蚕蚀性角膜溃疡的显微手术要领及临床疗效.方法 对经药物及(或)板层角膜移植术治疗无效或复发的蚕蚀性角膜溃疡6例(6眼),行双层羊膜移植术,观察术后角膜上皮及溃疡的愈合、基质水肿消退、新生血管萎缩、内外层羊膜转归及复发等情况.结果 随访24～34个月.外层羊膜多于术后7～11 d自溶吸收或脱落,予以拆线.7～15 d角膜上皮愈合,2～3周角膜基质水肿基本消退,2～3个月溃疡区新生血管逐渐萎缩,术后3个月内层羊膜与溃疡面牢固愈合,5～8个月病变区角膜渐呈半透明.随诊期内,4眼眼表稳定,未复发;另2眼因缝线暴露、未及时随诊拆线于术后12～13个月复发,再行板层角膜移植术,未再复发.结论 双层羊膜移植术在蚕蚀性角膜溃疡的治疗中具有很好的优势,显微手术技巧的掌握及严格复诊拆线是手术成功的关键,也为进一步角膜移植术的进行提供良好条件.     

双层羊膜移植治疗蚕蚀性角膜溃疡的显微技术探讨

目的 探讨双层羊膜移植术治疗蚕蚀性角膜溃疡的显微手术要领及临床疗效.方法 对经药物及(或)板层角膜移植术治疗无效或复发的蚕蚀性角膜溃疡6例(6眼),行双层羊膜移植术,观察术后角膜上皮及溃疡的愈合、基质水肿消退、新生血管萎缩、内外层羊膜转归及复发等情况.结果 随访24～34个月.外层羊膜多于术后7～11 d自溶吸收或脱落,予以拆线.7～15 d角膜上皮愈合,2～3周角膜基质水肿基本消退,2～3个月溃疡区新生血管逐渐萎缩,术后3个月内层羊膜与溃疡面牢固愈合,5～8个月病变区角膜渐呈半透明.随诊期内,4眼眼表稳定,未复发;另2眼因缝线暴露、未及时随诊拆线于术后12～13个月复发,再行板层角膜移植术,未再复发.结论 双层羊膜移植术在蚕蚀性角膜溃疡的治疗中具有很好的优势,显微手术技巧的掌握及严格复诊拆线是手术成功的关键,也为进一步角膜移植术的进行提供良好条件.     

双层羊膜移植治疗蚕蚀性角膜溃疡的显微技术探讨

目的 探讨双层羊膜移植术治疗蚕蚀性角膜溃疡的显微手术要领及临床疗效.方法 对经药物及(或)板层角膜移植术治疗无效或复发的蚕蚀性角膜溃疡6例(6眼),行双层羊膜移植术,观察术后角膜上皮及溃疡的愈合、基质水肿消退、新生血管萎缩、内外层羊膜转归及复发等情况.结果 随访24～34个月.外层羊膜多于术后7～11 d自溶吸收或脱落,予以拆线.7～15 d角膜上皮愈合,2～3周角膜基质水肿基本消退,2～3个月溃疡区新生血管逐渐萎缩,术后3个月内层羊膜与溃疡面牢固愈合,5～8个月病变区角膜渐呈半透明.随诊期内,4眼眼表稳定,未复发;另2眼因缝线暴露、未及时随诊拆线于术后12～13个月复发,再行板层角膜移植术,未再复发.结论 双层羊膜移植术在蚕蚀性角膜溃疡的治疗中具有很好的优势,显微手术技巧的掌握及严格复诊拆线是手术成功的关键,也为进一步角膜移植术的进行提供良好条件.     

双层羊膜移植治疗蚕蚀性角膜溃疡的显微技术探讨

目的 探讨双层羊膜移植术治疗蚕蚀性角膜溃疡的显微手术要领及临床疗效.方法 对经药物及(或)板层角膜移植术治疗无效或复发的蚕蚀性角膜溃疡6例(6眼),行双层羊膜移植术,观察术后角膜上皮及溃疡的愈合、基质水肿消退、新生血管萎缩、内外层羊膜转归及复发等情况.结果 随访24～34个月.外层羊膜多于术后7～11 d自溶吸收或脱落,予以拆线.7～15 d角膜上皮愈合,2～3周角膜基质水肿基本消退,2～3个月溃疡区新生血管逐渐萎缩,术后3个月内层羊膜与溃疡面牢固愈合,5～8个月病变区角膜渐呈半透明.随诊期内,4眼眼表稳定,未复发;另2眼因缝线暴露、未及时随诊拆线于术后12～13个月复发,再行板层角膜移植术,未再复发.结论 双层羊膜移植术在蚕蚀性角膜溃疡的治疗中具有很好的优势,显微手术技巧的掌握及严格复诊拆线是手术成功的关键,也为进一步角膜移植术的进行提供良好条件.     

Development of cultivated mucosal epithelial sheet transplantation for ocular surface reconstruction

Regenerative medicine via tissue engineering is a newly developed medical field based on the use of somatic stem cells to generate biological substitutes and improve tissue functions. The achievement of these objectives depends on two important factors: stem cells, which are high in proliferability and differentiability, and the substrates that support them. In order to reconstruct the ocular surface in patients with severe ocular surface diseases, we decided to investigate the feasibility of human amniotic membrane as an epithelial carrier, and found that denuded amniotic membrane was the most appropriate substrate for this purpose. To develop the surgical treatment using denuded amniotic membrane as a carrier, we established the tissue engineering system for making transplantable epithelial sheets of either corneal or oral mucosal epithelial cells for ocular surface reconstruction.     

采用羊膜移植行结膜囊成形术的临床研究

目的　评价保存人羊膜移植在结膜囊成形术中的疗效。方法　 31例无眼球结膜囊狭窄患者行结膜囊成形术时 ,结膜缺损用羊膜移植。结果　术后 2 2～ 30天移植的羊膜被结膜上皮覆盖 ,随访 12～ 36个月 ,无继发感染及排异反应 ,2 7例放置正常大小义眼片 ,外观满意 ,4例于术后 3～ 5个月出现结膜囊收缩。结论　保存人羊膜移植治疗结膜囊缩窄取材方便 ,疗效显著     

严重眼烧伤角巩膜溶解的显微手术治疗

目的 探讨治疗严重眼烧伤后角巩膜溶解的有效方法。方法 对于Ⅳ度眼烧伤出现角巩膜溶解，经药物治疗未能控制的病例，在手术显微镜下操作，应用组织粘合剂联合羊膜移植手术进行治疗11例。结果 术后11例患者中5眼巩膜溶解均得到控制，表面发生纤维血管化；8例角膜上皮化愈合，3例角膜溃疡得到有效抑制。结论 采用手术显微镜下进行组织粘合剂联合羊膜移植手术能有效阻止眼烧伤后的角巩膜溶解，维持眼球的完整性，为进一步的复明手术治疗创造良好的条件。     

组织工程角膜上皮联合羊膜移植治疗眼表化学伤效果观察

目的：探讨组织工程角膜上皮联合羊膜移植治疗眼表化学烧伤的临床效果.方法：34例（41只眼）跟表化学烧伤患者按来院先后顺序编号,随机分为两组.观察组18例（22只眼）行组织工程角膜上皮联合新鲜羊膜移植,对照组16例（19只眼）行结膜囊冲洗、前房冲洗和促角膜上皮生长药物点眼等治疗,观察两组临床疗效.术后随访观察角膜上皮化情况和视力恢复情况.结果：全部患者保存了眼球,观察组患者在术后1周内角膜植片水肿明显减轻,术后2～3周角膜缘植片基本透明,未见感染或排斥反应;术后4～6周内,眼表上皮重新上皮化,无瘢痕增生和新生血管化,角膜上皮修复好;术后视力较术前视力明显提高,差异有统计学意义（P〈0.05）;术后随访2～10个月,无假性胬肉及睑球粘连并发症发生.对照组3周内6例眼部炎症基本控制,3例眼部炎症持续超过21 d,4例角膜血管化,3例角膜持续性上皮缺损;治疗后视力较入院时视力变化差异无统计学意义（P〉0.05）.结论：组织工程角膜上皮联合羊膜移植是一种有效的治疗眼表化学烧伤的方法.     

羊膜和结膜基质诱导胚胎干细胞分化为上皮样细胞的初步研究

目的观察小鼠胚胎干细胞在保存人羊膜及兔眼表结膜基质上分化的情况。方法36只新西兰兔随机分为3组，每组12只。A组：将表达绿色荧光蛋白（green fluorescent protein，GFP）基因的小鼠ES-GFP细胞用5-溴脱氧尿嘧啶（BrdU）标记后行实验兔结膜下移植；B组：将小鼠ES—GFP细胞接种到人羊膜上共培养4d，用BrdU标记后移植到实验兔结膜缺损区；C组：采用保存羊膜移植到实验兔兔结膜缺损区。分别于移植后1、2、3、4，6和8周，摘取各组实验眼行荧光显微镜、组织学和免疫组织化学检查，荧光检测ES-GFP细胞在组织中的荧光表达，组织学检查移植到结膜基质的ES-GFP细胞的存活、形态变化以及移植局部的反应等情况；免疫组织化学检测移植到结膜基质的带有BrdU标记的ES．GFP细胞CK3／CK12和CK13的表达。结果小鼠ES-GFP细胞接种到人羊膜后能在羊膜上贴附生长，与羊膜共培养4d后部分ES-GFP细胞分化为多角形上皮样细胞，免疫组化显示β1整合素阳性。将负载有ES—GFP细胞的羊膜移植到兔结膜缺损区，术后荧光显微镜可在结膜上皮层检测到绿色荧光带，免疫组织化学检测结膜上皮层CK13表达阳性，CK3／CK12表达阴性，在重建的结膜上皮层可检测到BrdU核阳性细胞，未见异常增殖细胞。结论采用保存人羊膜负载小鼠ES细胞行兔结膜移植，小鼠ES细胞能在兔结膜基质存活并增殖。     

Effect of amniotic membrane on graft take in extremity burns

Background

Several studies have shown that the application of amniotic membrane as a biological dressing in the management of burns is accompanied by rapid re-epithelialisation and healing as it diminishes the oozing of plasma, bacterial count and fluid, protein and heat loss. This study evaluates the effect of amniotic membrane on graft take in split-thickness skin graft of extremity burns.

Methods

From October 2008 to January 2010, in a prospective clinical trial, 54 patients (108 limbs) with second and third degree burns, covering 4–15% of total body surface area (TBSA), were included in this study. All patients needed split-thickness skin grafts for burn-wound coverage. Selected patients had symmetric burns on two (upper or lower) extremities. Then in every patient, the extremities were randomly divided into two groups: in one limb, the skin graft was traditionally fixed with skin staples (control group) and in the other limb the skin graft was covered with an amniotic membrane (amnion group). Therefore, in every patient the graft was covered with an amniotic membrane in one extremity and fixed with skin staples in the other extremity. Finally, the duration and success rate of complete graft take was compared between the two groups.

Results

The study group was composed of 108 limbs in 54 patients (27 males and 27 females) with a mean age of 23.54 ± 4.9 years and burn 9.03 ± 2.69% TBSA. The mechanism of burn was flame (63%), scald (18.5%) and flash (18.5%). The rate of complete graft take was 96.76% and 88.79% in the amnion group and in the control group, respectively. The mean duration of graft take was 6.98 ± 1.35 days in the amnion group and 13.9 ± 1.66 days in the control group. This difference was statistically significant (P < 0.001).

Conclusions

Our results show that although the amniotic membrane has no negative impact on graft take, it significantly reduces the duration of complete graft take, which is very important for both the patient and the health-care system.     

Early experience in reconstruction of long ureteral strictures with allogenic amniotic membrane

Objective:   To present our experience with the application of human amniotic membrane for the reconstruction of extensive ureteral wall defects.
Methods:   Between 2003 and 2006, 11 patients underwent reconstructive surgery of the ureter. A human amniotic membrane allograft was used to supplement ureteral wall defects. Indications for the procedure included ureteral strictures of a 5.5 cm average (range, 3–8 cm) localized in different parts of the ureter: upper (5), middle (5) and lower (3). The etiology of ureteral loss was: postinflammatory after a complicated stone disease (5), iatrogenic (4) and idiopathic (2). Diagnosis of ureteral stricture was based on antegrade pyelography and excretory urography. Two patients had synchronous treatment for upper and middle ureteral stenosis. Treatment efficacy was assessed by excretory urography and ultrasound.
Results:   The mean hospitalization time was 11.9 days, mean operation time 128 min and with an average follow up of 25.2 months. Complications included: stricture recurrence (1) and symptomatic urinary tract infections (2). Excretory urography showed lack of obstruction and normal width of ureters. In one patient, residual hydronephrosis was present on ultrasound.
Conclusions:   The described method seems to be a promising tool in the reconstruction of extensive ureteral strictures.     

Amniotic stem cells repair ureteric defect: a study to evaluate the feasibility of amniotic membrane as a graft in surgical reconstruction

Background  

Amniotic membrane is considered a promising procedure as a graft in the field of ophthalmology and skin reconstruction. It has been shown to decrease inflammation, fibrosis, elicit no host immune reaction and also has antibiotic actions.     

羊膜移植联合碱性成纤维细胞生长因子滴眼液治疗兔角膜碱烧伤

目的 观察羊膜移植与碱性成纤维细胞生长因子(bFGF)滴眼液联合应用对兔角膜碱烧伤的治疗效果。方法 将60只新西兰白兔随机分为4组,分别为羊膜移植联合bFGF滴眼液点眼组(A组),羊膜移植组(B组),bFGF滴眼液点眼组(C组)及对照组(D组)。用1 mol/L NaOH烧伤兔右眼,术后2 ～28 d用裂隙灯显微镜观察角膜透明度,新生血管生长,角膜上皮修复及羊膜植片的变化。结果 所有烧伤角膜都能完全愈合,但在抑制炎症反应、抗新生血管的生长及角膜上皮修复等方面,羊膜移植联合bFGF滴眼液点眼组明显优于对照组,也好于其他两实验组,差异有统计学意义(P＜0.05)。结论 羊膜移植联合bFGF滴眼液点眼对治疗角膜碱烧伤有良好效果。