异种脱细胞真皮基质联合邻位皮瓣修复眼睑全层缺损的临床观察
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摘要
目的观察异种脱细胞真皮基质联合邻位皮瓣I期修复眼睑恶性肿瘤切除术后眼睑全层缺损的临床疗效。方法 35例(35眼)眼睑恶性肿瘤患者,其中基底细胞癌21例,睑板腺癌13例,鳞状细胞癌1例;累及上睑者12例,累及下睑者23例。所有患者均行术中冰冻并根据冰冻结果确定切缘,肿物切除后眼睑有不同程度全层缺损。取异种脱细胞真皮基质替代结膜睑板组织,根据皮肤缺损大小做邻近滑行或转位皮瓣修补眼睑缺损。术后观察皮瓣及口腔修复膜愈合情况、有无眼睑闭合不全及睑球粘连。结果随诊半年,异种脱细胞真皮基质已完全溶解,被爬行结膜上皮覆盖,皮瓣愈合良好、无一例皮瓣坏死。其中28例患者术后恢复良好,无眼睑闭合不全及睑内、外翻。4例患者出现轻度眼睑闭合不全,均无暴露性角膜炎。3例患者出现轻度睑球粘连。结论异种脱细胞真皮基质可替代睑板结膜组织,联合邻位皮瓣治疗眼睑恶性肿瘤切除术后的眼睑全层缺损有较好的临床疗效,可减少患者因取口唇黏膜或行二次眼睑重建的痛苦。
Objective To observe the clinical effects of eyelid reconstruction by regional flap combined with xenogeneic acellular dermal matrix transplantation for eyelid defect after malignant tumor excision.Methods Thirty-five cases( 35 eyes) in our hospital were selected as the objects.Among them,basal cell carcinoma was 21 cases,meibomian gland carcinoma was 13 cases,squamous cell carcinoma was 1 cases; 12 cases of upper eyelid and 23 case of lower eyelid were involved.All patients were subjected to intraoperative frozen,and the incision margin was determined according to the frozen results.After resection of the tumor,the eyelid had full-thickness defects in different degrees.The xenogenic acellular dermal matrix was used to replace the conjunctival tarsal tissue,and the adjacent flap or transposition flap was used to repair the eyelid defect according to the size of skin defect.The healing of flap,oral repair film,eyelid closure and adhesion were observed.Results After half a year follow-up,the acellular dermal matrix were completely dissolved by crawling the conjunctival epithelium covering,the flap healed with no flap necrosis.28 patients recovered well after operation without hypophasis and entropion,ectropion.4 patients had mild hypophasis,and there was no case of exposure keratitis.3 patients were with mild symblepharon.Conclusion The acellular dermal matrix can replace tarsal conjunctival tis-sue,which combined with regional flap has good clinical curative effect for eyelid defect after malignant tumor excision.This treatment can reduce the pain of patients who take oral mucosa and avoid the reoperation of eyelid reconstruction.
Objective To observe the clinical effects of eyelid reconstruction by regional flap combined with xenogeneic acellular dermal matrix transplantation for eyelid defect after malignant tumor excision.Methods Thirty-five cases( 35 eyes) in our hospital were selected as the objects.Among them,basal cell carcinoma was 21 cases,meibomian gland carcinoma was 13 cases,squamous cell carcinoma was 1 cases; 12 cases of upper eyelid and 23 case of lower eyelid were involved.All patients were subjected to intraoperative frozen,and the incision margin was determined according to the frozen results.After resection of the tumor,the eyelid had full-thickness defects in different degrees.The xenogenic acellular dermal matrix was used to replace the conjunctival tarsal tissue,and the adjacent flap or transposition flap was used to repair the eyelid defect according to the size of skin defect.The healing of flap,oral repair film,eyelid closure and adhesion were observed.Results After half a year follow-up,the acellular dermal matrix were completely dissolved by crawling the conjunctival epithelium covering,the flap healed with no flap necrosis.28 patients recovered well after operation without hypophasis and entropion,ectropion.4 patients had mild hypophasis,and there was no case of exposure keratitis.3 patients were with mild symblepharon.Conclusion The acellular dermal matrix can replace tarsal conjunctival tis-sue,which combined with regional flap has good clinical curative effect for eyelid defect after malignant tumor excision.This treatment can reduce the pain of patients who take oral mucosa and avoid the reoperation of eyelid reconstruction.
引文
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[3]董志军,杨洁,张铁民.自体硬腭黏膜移植修复眼睑缺损的疗效观察[J].中国医科大学学报,2011,40(10):922-924.DONG ZJ,YANG J,ZHANG TM.Therapeutic observation of autogenous hard palate mucosa graft for the reconstruction of eyelid defect[J].J Chin Med Univ,2011,40(10):922-924.
[4]陈家祺,顾建军,彭鸿钧,黄挺,陈龙山,周世有.应用同种异体脱细胞真皮的眼睑原位重建术[J].中华眼科杂志,2005,41(5):409-413.CHEN JQ,GU JJ,PENG HJ,HUANG T,CHEN LS,ZHOU SY.The eyelid reconstruction in situ with allograft acellular dermal matrix[J].Chin J Ophthalmol,2005,41(5):409-413.
[5]马朝霞,刘德成.异体睑板结膜在眼睑肿瘤切除术中的临床应用[J].中国美容医学,2016,25(6):73-74.MA ZX,LIU DC.Clinical application of allogeneic scleral and conjunctival for eyelid tumor resection[J].Chin J Aesthetic Med,2016,25(6):73-74.
[6]赵茂竹,林伟,陆君华.口腔修复膜在结膜囊成形术中的应用[J].国际眼科杂志,2013,13(12):2465-2467.ZHAO MZ,LIN W,LU JH.Clinical application of prosthodontics membrane in conjunctival sac plasty[J].Int Eye Sci,2013,13(12):2465-2467.
[7]高长华,张向荣,周琼,裴重刚.异种(牛)脱细胞真皮在结膜囊成形术中的临床应用[J].眼科新进展,2012,32(7):648-650,653.GAO CH,ZHANG XR,ZHOU Q,PEI CG.Clinical application of xenogeneic(bovine)acellular dermal matrix in conjunctival sac reconstruction[J].Rec Adv Ophthalmol,2012,32(7):648-650,653.
[8]SHORR N,PERRY JD,GOLDBERG RA,HOENIG J,SHORR J.The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery[J].Ophthalmic Plast Reconstr Surg,2000,16(3):223-230.
[9]刘强,冯瑞,孟爱华,贺立新,杨红明,柴家科.异种去细胞真皮基质在体内转归的初步研究[J].中国危重病急救医学,2006,18(1):49-51.LIU Q,FENG R,MENG AH,HE LX,YANG HM,CHAI JK.Preliminary study on outcome of xenogeneic(porcine)acellular dermal matrix in vivo[J].Chin Cri Care Med,2006,18(1):49-51.
[10]郭玉瑞.脱细胞异体真皮在面部填充中的应用[J].新乡医学院学报,2013,30(6):490-491.GUO YR.Application of heterogeneous acellular dermal matrix in facial filling[J].J Xinxiang Med Coll,2013,30(6):490-491.
[2]冯洁,王志安,殷岩,范先群,孙英.眼睑恶性肿瘤切除术后Ⅰ期眼睑重建的手术方法探讨[J].临床眼科杂志,2010,18(3):235-236.FENG J,WANG ZA,YIN Y,FAN XQ,SUN Y.Surgical approaches investigation of immediate eyelid reconstruction after the operation of malignant tumors of eyelids[J].J Clin Ophthalmol,2010,18(3):235-236.
[3]董志军,杨洁,张铁民.自体硬腭黏膜移植修复眼睑缺损的疗效观察[J].中国医科大学学报,2011,40(10):922-924.DONG ZJ,YANG J,ZHANG TM.Therapeutic observation of autogenous hard palate mucosa graft for the reconstruction of eyelid defect[J].J Chin Med Univ,2011,40(10):922-924.
[4]陈家祺,顾建军,彭鸿钧,黄挺,陈龙山,周世有.应用同种异体脱细胞真皮的眼睑原位重建术[J].中华眼科杂志,2005,41(5):409-413.CHEN JQ,GU JJ,PENG HJ,HUANG T,CHEN LS,ZHOU SY.The eyelid reconstruction in situ with allograft acellular dermal matrix[J].Chin J Ophthalmol,2005,41(5):409-413.
[5]马朝霞,刘德成.异体睑板结膜在眼睑肿瘤切除术中的临床应用[J].中国美容医学,2016,25(6):73-74.MA ZX,LIU DC.Clinical application of allogeneic scleral and conjunctival for eyelid tumor resection[J].Chin J Aesthetic Med,2016,25(6):73-74.
[6]赵茂竹,林伟,陆君华.口腔修复膜在结膜囊成形术中的应用[J].国际眼科杂志,2013,13(12):2465-2467.ZHAO MZ,LIN W,LU JH.Clinical application of prosthodontics membrane in conjunctival sac plasty[J].Int Eye Sci,2013,13(12):2465-2467.
[7]高长华,张向荣,周琼,裴重刚.异种(牛)脱细胞真皮在结膜囊成形术中的临床应用[J].眼科新进展,2012,32(7):648-650,653.GAO CH,ZHANG XR,ZHOU Q,PEI CG.Clinical application of xenogeneic(bovine)acellular dermal matrix in conjunctival sac reconstruction[J].Rec Adv Ophthalmol,2012,32(7):648-650,653.
[8]SHORR N,PERRY JD,GOLDBERG RA,HOENIG J,SHORR J.The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery[J].Ophthalmic Plast Reconstr Surg,2000,16(3):223-230.
[9]刘强,冯瑞,孟爱华,贺立新,杨红明,柴家科.异种去细胞真皮基质在体内转归的初步研究[J].中国危重病急救医学,2006,18(1):49-51.LIU Q,FENG R,MENG AH,HE LX,YANG HM,CHAI JK.Preliminary study on outcome of xenogeneic(porcine)acellular dermal matrix in vivo[J].Chin Cri Care Med,2006,18(1):49-51.
[10]郭玉瑞.脱细胞异体真皮在面部填充中的应用[J].新乡医学院学报,2013,30(6):490-491.GUO YR.Application of heterogeneous acellular dermal matrix in facial filling[J].J Xinxiang Med Coll,2013,30(6):490-491.