预制以扩张器包膜作为衬里的推进皮瓣重建完全性上睑缺损

发布时间：2018-06-27 03:51

本文选题：扩张皮瓣 + 纤维包膜　；参考：《中国协和医科大学》2010年硕士论文

【摘要】： 目的：探讨预制以扩张器植入机体后形成的纤维包膜作为衬里的推进皮瓣,修复完全性上睑缺损的可行性。背景：完全性上睑缺损在临床上是比较罕见的难题,主要见于肿瘤切除、外伤以及先天性畸形。重建完全性上睑缺损包括两个基本层次：外层富于弹性的皮肤和内层滑润的结膜。笔者观察到皮肤软组织扩张器植入机体后形成的纤维包膜,具有光滑、湿润的滑膜样外观,和正常的睑结膜相似。于是设计了预制以纤维包膜为衬里的推进皮瓣重建实验动物兔的完全性上睑缺损。方法：31只新西兰白兔分别在额部皮下植入10ml圆形扩张器,持续扩张6到8周。应用额部推进皮瓣(带扩张器植入后形成的纤维包膜)修复全层上眼睑的矩形缺损。观察纤维包膜作为眼睑衬里的转归：分别在3天、1周、2周、1个月、2个月、4个月取标本进行组织学检测。在推进皮瓣修复兔完全性上睑缺损2个月以后,我们选择从内眦点到外眦点上睑缘长度的改变,作为反映皮瓣挛缩的一维参数。结果：大体观察术后2个月：眼裂水平距离缩短,球结膜和角膜无损伤,作为衬里的纤维包膜表面湿润、光滑,较正常睑结膜颜色略白。组织学检测可见,推进皮瓣术后1周包膜层有大量炎症细胞浸润；术后1个月有单层扁平样上皮形成；术后2个月纤维包膜转化为复层柱状上皮,并且可以发现杯状细胞,接近正常的睑结膜层。上睑缘长度平均回缩率不明显为10.9±6.7%。结论：扩张器包膜为衬里的推进皮瓣重建实验动物兔的大面积上睑缺损是可行的,重建的眼睑呈现令人满意的皮瓣颜色和厚度。纤维包膜作为睑结膜的替代物为大面积全层眼睑缺损的修复提供了细胞重建的平台、抗感染的屏障。目的：探讨一种在眼轮匝肌悬吊法下睑袋切除术中,通过完全松解眼轮匝肌支持韧带,使附着在眶缘骨膜上松弛的皮肤、皮下组织得以充分释放,达到下睑组织和眶颧组织整体提紧效果的改良手术方法。方法：对409例具有较明显沟槽畸形的患者,行眼轮匝肌悬吊法下睑袋切除术过程中,增加了眼轮匝肌支持韧带离断、眼轮匝肌支持韧带断端上提与眶隔筋膜固定的手段,改进眼轮匝肌悬吊法下睑袋切除术。结果：2006年开始应用本法治疗下睑袋共409例,女391例,男18例,年龄在31-75岁,术后随访1-3年。其中轻度者16例下睑皮肤和眼轮匝肌松弛完全平复,外观良好。中度者354例中,352例下睑皮肤和眼轮匝肌松弛完全改善,外观良好,2例皮肤仍有轻度松弛,但较术前明显改观。重度者39例中,36例下睑皮肤和眼轮匝肌松弛完全改善,3例仍有皮肤轻度松弛及眶脂膨出,但较术前明显改善。390例沟槽畸形术后明显改观,无一例增多,其中有3例眼袋较严重者,在半年内感到下眼袋尚未完全去除,5例行第二次手术。约1/6患者术后早期外眦部可扪及一小硬结(线结),1-2个月左右消除。术后一般常见有闭眼时外眦部牵扯感,数日内缓解。术后下睑区皮肤平坦,鼻颊沟和眶颊沟消失。全部手术效果满意,无一例出现睑外翻及凹陷畸形等术后并发症。结论：这种改良的下睑袋切除术,松解了眶颧部皮肤,有利于恢复睑颊复合体的平整自然,对解决沟槽畸形尤其有效。此方法简单易行,安全性高,可作为下睑袋年轻化手术很好的选择。
[Abstract]:Objective : To investigate the feasibility of repairing the complete upper eyelid defect by using the fibrous capsule formed after implantation of the dilator into the body as the advanced skin flap .

BACKGROUND : Complete upper eyelid defect is a rare problem in clinic , mainly in tumor resection , trauma and congenital deformity . Reconstruction of complete upper eyelid defect includes two basic layers : the outer layer is rich in elastic skin and the inner layer of slippery conjunctiva .

Methods : 31 New Zealand white rabbits were implanted into 10 ml round expander subcutaneously at the forehead for 6 to 8 weeks .

Results : After 2 months after operation , the level of ocular fissure was shortened , the bulbar conjunctiva and the cornea were not damaged , the surface of the fibrous capsule as lining was wet , smooth , and the color of the conjunctiva was slightly white . The histological examination showed that there was a large amount of inflammatory cell infiltration in the perimembranous layer after the skin flap operation .
There was a single layer of flat epithelium in 1 month after operation .
The fibrous capsule was transformed into stratified columnar epithelium in 2 months after operation , and the cup - shaped cells were found close to the normal eyelid conjunctiva . The average retraction rate of upper eyelid margin was not significantly 10.9 卤 6.7 % .

Conclusion : It is feasible to reconstruct the large - area upper eyelid defect of the experimental animal rabbits by the advance flap of the dilator capsule , and the reconstructed eyelid presents a satisfactory skin flap color and thickness . The fibrous capsule as a substitute for the eyelid conjunctiva provides a platform for cell reconstruction and an anti - infection barrier for the repair of the large - area full - layer eyelid defect .

Objective : To study the improvement of the overall lifting effect of lower eyelid tissue and supraorbital zygoma by fully releasing the orbicularis muscle of the orbicularis muscle to support the ligament by fully releasing the orbicularis muscle of the orbicularis muscle to support the ligament .

Methods : 409 patients with obvious groove deformity were treated with orbicularis orbicularis muscle suspension method under the orbicularis orbicularis muscle suspension method .

Results : In 2006 , 409 cases of lower eyelid were treated with this method , including 391 cases , male 18 cases , age 31 - 75 years and follow - up for 1 - 3 years .

Conclusion : This modified lower eyelid bag resection is beneficial to the restoration of the smooth nature of the buccal complex , which is beneficial to the restoration of the smooth nature of the buccal complex . The method is simple and easy to implement and has high safety . It can be used as a good choice for the younger operation of the lower eyelid bag .
【学位授予单位】：中国协和医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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