摘要
目的:干眼病至今无特效疗法,临床界对腮腺管移植术的褒贬不一。本文从临床上探讨腮腺管移植术的价值,究竟可否用以治疗干眼病。方法:42年来共作40只眼的腮腺管移植术,观察3周至6年余。本文从手术前后泪流和视力的变化,以及干眼病病因、手术方法、腺管长度和双侧施术的并发症等方面予以总结。结果:在40只术眼中,术后82.5％有泪流,最终无泪者27.5％;72.5％视力增加,无减退例。3例加作角膜移植术后,视力均获提高。口内法和口外法的手术效果无差异。腺管长度7.5％过短,用口粘膜造假管道术均获满意解决。双侧施术4例,仅1例术后发生齿槽脓肿和口干、治疗后愈。沙眼性干眼25只眼:术后全部出现泪流,泪量在进餐时全部大量,平时则96％为大及中量,但3只眼最终变无泪(2眼因感染)。眼类天疱疮4只眼:术后3只眼无泪,1眼小量,最后也变无泪。Stevens-Johnson综合征9只眼:术后6只眼出现泪流,量小,其中2眼的泪量基本正常。碱性眼伤2只眼,术后只1眼出现泪流,因仅观察1月,远期结果不明。结论:腮腺管移植术操作简易,无并发症;而干眼病至今无特效疗法,故应考虑是一个值得临床采用的手术。但,眼类天疮疮无效;沙眼性干眼的手术成功率高,却术后泪水过多;Stevens-John-son综合征的成功率低于沙眼,但有可能取得泪量近乎正常的满意结?
Purpose: As today the effect of parotid duct transplantation is clinically regarded as uncertainty, and there is still absent of effective managenent of the dry eye, this paper tries to clarify its value, and see if it can be used clinically. Methods: Forty dry eyes were operated with a follow-up of 3 weeks to more than 6 years in the past 42 yesrs. The pre-and postoperative changes of tear flow and vision, and the cause of dry eye, operative method, length of parotid duct and complications of bilateral operation were briefly summarized.Results: Of these 40 operated eyes postoperatively, 82. 5% had tearing, but no tearing occurred in 27. 5% finally; vision increased in 72. 5% with out any decrease. There was no difference in the results whether the procedure done extrao-rally or intraorally. The parotid duct being shorter was only seen in 7. 5%, which were satisfactorily managed by tube-making with oral mucosa. Four cases operated binocularly and silmutaneously. only 1 occurred aveolar abscess with plaining dry mouth, but cured 1 week later. After operation, profusive tearing occurred in 25 dry eyes caused by trachoma during eating and 96% usually, but tearing stopped finally in 3 eyes (2, due to infection). Four dry eyes with ocular pemphigoid failed. Among 9 dry eyes resulted from Stevens-Johnson syndrome, 6 had little tearing postoperatively, 2 of which attained a nearly normal results. One of the two dry eyes resulted from alkali eye burn failed and the other , occurred tearing but only followed-up for 1 month, the result was uncertain. Conclusion : As the technique of the parotid duct transplantation is simple and easy with no much complications , and for treating the dry eye , there is up to now still absent of effective management, therefore, the parotid duct transplantation should be considered to be indicated in dry eyes esp. caused by Stevens-Johnson syndrome. Though its success rate is lower than that of traucomatous ones, the satisfactory result of nearly normal postoperative tearing may be got. In ocular pemphigoid, however, it is contraindicated. Eye Science 1995; 11:67-69.
出处
《眼科学报》
1995年第2期67-69,共3页
Eye Science
