摘要：
目的: 应用血管化自体下颌下腺移植的方法治疗重症角结膜干燥症，并评价其疗效。方法: 纳入重症角结膜干燥症患者4例，将患者下颌下腺移植至颞部，完成血管吻合，并将移植腺体导管重新开口于患眼。术后监测移植腺体血运并调控其分泌功能，对患眼治疗效果进行评估。结果: 2017—2019年共治疗了4例患者的5只眼，其中1例接受双侧眼部手术。所有患者手术均获成功，核素显像证实移植腺体均成活。经术后功能调控治疗，移植腺体分泌适当。随访结果显示：希尔默试验由术前的0 mm/5 min升至术后的15 mm/5 min；眼表结构改善明显，泪膜破裂时间由术前的0 s增加至术后6 s；患者角膜荧光染色评分降低，视力出现不同程度的提高。主观评价结果显示，患者术后眼干症状改善，所有患者均停止使用人工泪液。结论: 在具备显微外科技术的条件下，自体下颌下腺移植手术的成功率较高，是治疗重症角结膜干燥症的有效方法。
关键词:
下颌下腺移植,
角结膜干燥症,
显微外科
Abstract:
Objective: Microvascular autologous submandibular gland transplantation was used to treat severe cases of keratoconjunctivitis sicca, and its curative effect was evaluated. Methods: A total of 4 patients of severe keratoconjunctivitis sicca were included. Submandibular glands were transplanted to the temporal region with anastomosis of the vessels. The submandibular gland were re-opened into the eyes. Blood circulation of the transplanted glands was monitored and the secretory function was artificially regulated. The therapeutic effect of the patients was evaluated. Results: From 2017 to 2019, submandibular gland transplantation was performed in 5 eyes of 4 patients (bilateral transplantations in one patient). All surgeries were successful with graft vitality confirmed by scintigraphy. Lubrication of the eyes was suitable after regulation of the secretory function of the grafts. Follow-up results showed that mean Schirmer’s test values increased from a preoperative level of 0 mm/5 min to 15 mm/5 min postoperatively, and tear film break-up time(BUT) improved from 0 s to 6 s. Fluorescein(FI) scores reduced and postoperative best-corrected visual acuity improved. The result of subjective evaluation showed that the symptoms of dry eye were improved and use of artificial tear substitutes was discontinued in all patients. Conclusion: Based on the technology of microsurgery, the submandibular gland transplantation surgery can be successfully handled and used as an effective treatment method for severe keratoconjunctivitis sicca.
Key words:
submandibular gland transplantation,
keratoconjunctivitis sicca,
microvascular surgery
中图分类号:
马旭亮, 任玉峰, 蔡现良, 王超, 张培成, 苏家增. 血管化自体下颌下腺移植治疗重症角结膜干燥症的初步研究[J]. 《口腔颌面外科杂志》, 2021, 31(1): 42-46.
MA Xuliang, REN Yufeng, CAI Xianliang, WANG Chao, ZHANG Peicheng, Su Jiazeng. A Preliminary Study of Microvascular Autologous Submandibular Gland Transplantation in Treatment of Severe Cases of Keratoconjunctivitis Sicca[J]. 《Journal of Oral and Maxillofacial Surgery》, 2021, 31(1): 42-46.