Microvascular autologous transplantation of partial submandibular gland for severe keratoconjunctivitis sicca
Microvascular autologous transplantation of partial submandibular gland for severe keratoconjunctivitis sicca
复制标题
自体微血管部分颌下腺移植治疗重症干燥性角结膜炎
DOI：
10.1136/bjophthalmol-2013-303280
复制
发表时间：
2013-09-01
影响因子：
4.1
通讯作者：
Yu, Guang-yan
中科院分区：
文献类型：
--
作者：
Qin, Jian;Zhang, Lei;Yu, Guang-yan
目的探讨自体微血管移植部分颌下腺（SMG）预防或减少严重干燥性角结膜炎（KCS）溢泪的可行性。方法 2006年1月至2009年12月收治KCS患者39例42只眼，随机接受部分或全部SMG移植。比较两组移植SMG存活率、最佳矫正视力眼科特征、Schirmer试验结果、泪膜破裂时间（BUT）、荧光染色、术后溢泪发生率及后续手术频率等临床资料。结果 22只眼进行全SMG移植，其余20只眼进行部分SMG移植。所有移植的 SMG 均存活下来。 1例部分SMG移植出现微血管危象，但探查清除静脉血栓后腺体存活。 1 例部分 SMG 移植中导管口阻塞的问题通过导管口重建得到解决。干眼症状消失，患者能够停止使用人工泪液。接受部分 SMG 移植的 6 只眼和接受完全 SMG 移植的 19 只眼发生严重溢泪（p<0.01）。 6只眼接受部分SMG移植，18只眼接受全SMG移植（p<0.01）。结论 部分SMG微血管移植治疗重度KCS是可行、有效的，且不降低移植SMG的存活率。对于功能正常的充足SMG，部分SMG移植可缓解干眼症状，并显着降低术后严重溢泪的发生率。
Objective To evaluate the feasibility of microvascular autologous transplantation of partial submandibular gland (SMG) to prevent or reduce epiphora in severe keratoconjunctivitis sicca (KCS). Methods A total of 39 patients with KCS, covering 42 eyes, were randomised to undergo transplantation of partial or total SMG from January 2006 to December 2009. Clinical data of survival rate of transplanted SMG, ophthalmologic features of best-corrected visual acuity, Schirmer test results, break-up time (BUT) of tear film, fluorescence staining, incidence of postoperative epiphora and frequency of subsequent surgery were compared between two groups. Results Total SMG transplantation was performed in 22 eyes, and partial SMG transplantation was performed in the other 20 eyes. All transplanted SMGs survived. Microvascular crisis occurred in one case of partial SMG transplantation, but the gland survived after exploration to remove the venous thrombus. Obstruction of the ductal orifice in one case of partial SMG transplantation was resolved by reconstruction of the ductal orifice. Symptoms of dry eyes disappeared, and patients were able to discontinue use of artificial tears. Severe epiphora occurred in 6 eyes undergoing partial SMG transplantation and in 19 eyes undergoing total SMG transplantation (p<0.01). Surgical reduction was performed in 6 eyes undergoing partial SMG transplantation and 18 eyes undergoing total SMG transplantation (p<0.01). Conclusions Microvascular transplantation of partial SMG is feasible and effective for severe KCS and does not decrease the survival rate of transplanted SMG. For ample SMGs with normal function, transplantation of partial SMG alleviates the symptoms of dry eye and significantly reduces the incidence of severe postoperative epiphora.