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

发布时间：2018-05-30 09:07

本文选题：眼睑缺损 + 眼睑恶性肿瘤　；参考：《眼科新进展》2017年07期

【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。
[Abstract]:Objective to observe the clinical effect of xenogeneic acellular dermal matrix combined with adjacent skin flap in the repair of eyelid full-layer defect after eyelid malignant tumor resection. Methods 35 cases (35 eyes) with malignant tumor of eyelid, including 21 cases of basal cell carcinoma, 13 cases of tarsal carcinoma, 1 case of squamous cell carcinoma, 12 cases of upper eyelid involvement and 23 cases of lower eyelid involvement. All the patients underwent intraoperative freezing and the cutting margin was determined according to the frozen results. Acellular dermal matrix was used to replace the conjunctival tarsal tissue, and the skin defect was repaired with adjacent glide or transposition skin flap according to the size of the skin defect. After operation, the healing of flap and oral repair membrane was observed, and there was no eyelid closure and symblepharon. Results after six months of follow-up, the xenogeneic acellular dermal matrix was completely dissolved, covered by the reptile conjunctiva epithelium, the skin flap healed well, and no flap necrosis was found. Among them, 28 cases recovered well after operation, there was no eyelid incompetence and inner eyelid, 4 cases with valgus appeared mild eyelid incompetence, and none of them had mild symblepharon in 3 cases of exposed keratitis. Conclusion xenogeneic acellular dermal matrix can replace the conjunctival tissue of tarsal plate and combined with adjacent skin flap for the treatment of eyelid full layer defect after resection of malignant tumor of eyelid. It can reduce the pain of taking lip mucosa or reconstructing the eyelid.
【作者单位】：南昌大学第二附属医院眼科;
【分类号】：R739.7

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