104例角膜病行穿透性角膜移植术后排斥反应的临床病例分析

发布时间：2018-02-13 22:19

本文关键词： 穿透性角膜移植术免疫排斥反应临床防治　出处：《吉林大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的:总结我院自2007年1月至2009年6月行穿透性角膜移植术并有术后定期随访患者的临床病例,对患者的年龄、病因、术前患眼情况及伴随症状等与角膜移植排斥反应的关系进行分析,探讨排斥反应发生机理,并对排斥反应进行治疗。方法:对行穿透性角膜移植术的104例(104只眼)进行回顾性研究。结果:本组病例行穿透性角膜移植术的最常见病因为角膜白斑,共49例,占总数47.1%,这与患眼的病程和某些客观原因有关;第二位的病因为感染性角膜炎,共28例,占总数46.4%,其中真菌性角膜炎又为多发病因,共有20例,占71.4%;其次为大泡性角膜病变,共7例,占总数6.7%;角膜脓肿4例,占3.8%,角膜变性和角膜营养不良5例,占4.8%;其它8例,占7.6%。术前患眼的伴随症状也是影响术后免疫排斥反应发生率的主要原因之一。本组病例中患眼伴随症状多且复杂,主要有角膜新生血管,虹膜粘连,陈旧性虹膜睫状体炎,术前浅前房和虹膜新生血管。从总体上看,虹膜粘连、角膜新生血管、陈旧虹膜睫状体炎、前房积脓这些患眼伴随症状所导致的术后免疫排斥反应发生率高。本组104例中,发生排斥反应有38例。排斥反应发生率为36.5%。排斥反应发生的时间跨度大,最早的发生在术后29天,多数发生在3个月以后,也有在术后一年出现排斥反应的。对于术后发生排斥反应治疗为局部或全身激素及免疫抑制剂治疗。但结合临床观察,排斥反应的早期发现和早期治疗很重要。
[Abstract]:Objective: to summarize the clinical cases of penetrating keratoplasty performed in our hospital from January 2007 to June 2009, and to evaluate the age and etiology of the patients. The relationship between preoperative ocular condition and associated symptoms and corneal allograft rejection was analyzed, and the mechanism of rejection was discussed, and the rejection was treated. Methods: 104 cases (104 eyes) with penetrating keratoplasty were studied retrospectively. Results: the most common cause of penetrating keratoplasty was corneal leukoplakia (49 cases), accounting for 47.1% of the total, which was related to the course of the affected eyes and some objective causes, and the second cause was infectious keratitis (28 cases). Among them, fungal keratitis was the most common cause, accounting for 71.4%, 7 cases (6.7%) of macrovesicular keratopathy; 4 cases of corneal abscess (3.8%), 5 cases of corneal degeneration and corneal dystrophy (4.8 cases); and 8 cases of other 8 cases (7.6%). The concomitant symptoms of the eyes before operation were also one of the main factors affecting the incidence of postoperative immune rejection. In this group, the associated symptoms were many and complicated, including corneal neovascularization, iris adhesion, and old iridocyclitis. Generally speaking, the incidence of postoperative immune rejection caused by iridia adhesion, corneal neovascularization, obsolete iridocyclitis and anterior chamber pyosis were high. There were 38 cases of rejection in 104 cases. The incidence of rejection was 36.5%. The earliest time span of rejection occurred in 29 days after operation, most of which occurred after 3 months, and there was also rejection in one year after operation. Local or systemic hormone and immunosuppressant are used in the treatment of postoperative rejection, but combined with clinical observation, the early detection and early treatment of rejection is very important.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.65

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