中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2012年
1期
27-32
,共6页
陈酉%晏晓明%吴海荣%荣蓓
陳酉%晏曉明%吳海榮%榮蓓
진유%안효명%오해영%영배
羊膜%移植%大鼠%角膜%烧伤,化学
羊膜%移植%大鼠%角膜%燒傷,化學
양막%이식%대서%각막%소상,화학
Amnion%Transplantation%Rats%Cornea%Burns,chemical
目的 比较嵌入法、覆盖法及无缝线三种羊膜移植方法治疗大鼠角膜碱烧伤模型在手术时间、羊膜溶解时间以及羊膜溶解后与角膜融合的位置关系的区别,为临床不同羊膜移植方法的选择提供实验依据.方法 实验研究.将SD大鼠随机分为5组,分别为A组(角膜单纯碱烧伤)、B组(嵌入法)、C组(覆盖法)、D组(无缝线)、E正常对照组.将A、B、C、D组制备角膜碱烧伤模型,B、C、D组24 h内分别行嵌入法、覆盖法及无缝线羊膜移植术,记录手术时间,术后裂隙灯显微镜观察术眼羊膜情况,以羊膜4/5以上溶解为时间点记录羊膜溶解时间,对羊膜融解后的角膜进行HE染色及免疫组织化学染色并进行半定量分析,观察羊膜融解后羊膜组织在角膜中是否存在,以及在角膜中存在的位置.手术时间及溶解时间的比较采用单因素方差分析,免疫组织化学染色结果及角膜融合位置关系采用多组秩和检验.结果 (1)无缝线羊膜移植手术时间为(9.875±1.246) min,较嵌入法羊膜移植手术时间( 35.500 ±2.878) min和覆盖法羊膜移植手术时间(33.375±2.973) min明显缩短；(2)三种羊膜移植方法术后羊膜溶解时间不同,嵌入法羊膜移植术后羊膜溶解时间为(16.625 ±3.662)d；覆盖法羊膜移植术后羊膜溶解时间为(9.250±2.188)d；无缝线法羊膜移植术后羊膜溶解时间为( 12.833±2.483)d.3种方法羊膜移植术后羊膜溶解时间差异有统计学意义(F=13.067,P＜0.00l),且各组间羊膜移植术后羊膜溶解时间差异均有统计学意义,其中嵌入法羊膜移植术后羊膜溶解时间最长,覆盖法羊膜移植术后羊膜溶解时间最短；(3)HE染色可见传统方法羊膜移植手术中缝线部位有大量炎性细胞浸润,而无缝线羊膜移植中无明显炎症反应；(4)羊膜溶解后羊膜与角膜融合的位置关系可分为三种,即羊膜位于角膜上皮表面、角膜上皮层间及角膜基质间,且同一种羊膜移植方法中羊膜与角膜融合的位置关系可以是以上3种位置关系中的一种或多种同时存在,但差异无统计学意义(H=4.206,P=0.122).结论 羊膜溶解后可存在于角膜组织中,无缝线羊膜移植较传统羊膜移植方法手术时间短、炎症反应轻,在角膜视路病变治疗中具有更广阔的应用前景.
目的 比較嵌入法、覆蓋法及無縫線三種羊膜移植方法治療大鼠角膜堿燒傷模型在手術時間、羊膜溶解時間以及羊膜溶解後與角膜融閤的位置關繫的區彆,為臨床不同羊膜移植方法的選擇提供實驗依據.方法 實驗研究.將SD大鼠隨機分為5組,分彆為A組(角膜單純堿燒傷)、B組(嵌入法)、C組(覆蓋法)、D組(無縫線)、E正常對照組.將A、B、C、D組製備角膜堿燒傷模型,B、C、D組24 h內分彆行嵌入法、覆蓋法及無縫線羊膜移植術,記錄手術時間,術後裂隙燈顯微鏡觀察術眼羊膜情況,以羊膜4/5以上溶解為時間點記錄羊膜溶解時間,對羊膜融解後的角膜進行HE染色及免疫組織化學染色併進行半定量分析,觀察羊膜融解後羊膜組織在角膜中是否存在,以及在角膜中存在的位置.手術時間及溶解時間的比較採用單因素方差分析,免疫組織化學染色結果及角膜融閤位置關繫採用多組秩和檢驗.結果 (1)無縫線羊膜移植手術時間為(9.875±1.246) min,較嵌入法羊膜移植手術時間( 35.500 ±2.878) min和覆蓋法羊膜移植手術時間(33.375±2.973) min明顯縮短；(2)三種羊膜移植方法術後羊膜溶解時間不同,嵌入法羊膜移植術後羊膜溶解時間為(16.625 ±3.662)d；覆蓋法羊膜移植術後羊膜溶解時間為(9.250±2.188)d；無縫線法羊膜移植術後羊膜溶解時間為( 12.833±2.483)d.3種方法羊膜移植術後羊膜溶解時間差異有統計學意義(F=13.067,P＜0.00l),且各組間羊膜移植術後羊膜溶解時間差異均有統計學意義,其中嵌入法羊膜移植術後羊膜溶解時間最長,覆蓋法羊膜移植術後羊膜溶解時間最短；(3)HE染色可見傳統方法羊膜移植手術中縫線部位有大量炎性細胞浸潤,而無縫線羊膜移植中無明顯炎癥反應；(4)羊膜溶解後羊膜與角膜融閤的位置關繫可分為三種,即羊膜位于角膜上皮錶麵、角膜上皮層間及角膜基質間,且同一種羊膜移植方法中羊膜與角膜融閤的位置關繫可以是以上3種位置關繫中的一種或多種同時存在,但差異無統計學意義(H=4.206,P=0.122).結論 羊膜溶解後可存在于角膜組織中,無縫線羊膜移植較傳統羊膜移植方法手術時間短、炎癥反應輕,在角膜視路病變治療中具有更廣闊的應用前景.
목적 비교감입법、복개법급무봉선삼충양막이식방법치료대서각막감소상모형재수술시간、양막용해시간이급양막용해후여각막융합적위치관계적구별,위림상불동양막이식방법적선택제공실험의거.방법 실험연구.장SD대서수궤분위5조,분별위A조(각막단순감소상)、B조(감입법)、C조(복개법)、D조(무봉선)、E정상대조조.장A、B、C、D조제비각막감소상모형,B、C、D조24 h내분별행감입법、복개법급무봉선양막이식술,기록수술시간,술후렬극등현미경관찰술안양막정황,이양막4/5이상용해위시간점기록양막용해시간,대양막융해후적각막진행HE염색급면역조직화학염색병진행반정량분석,관찰양막융해후양막조직재각막중시부존재,이급재각막중존재적위치.수술시간급용해시간적비교채용단인소방차분석,면역조직화학염색결과급각막융합위치관계채용다조질화검험.결과 (1)무봉선양막이식수술시간위(9.875±1.246) min,교감입법양막이식수술시간( 35.500 ±2.878) min화복개법양막이식수술시간(33.375±2.973) min명현축단；(2)삼충양막이식방법술후양막용해시간불동,감입법양막이식술후양막용해시간위(16.625 ±3.662)d；복개법양막이식술후양막용해시간위(9.250±2.188)d；무봉선법양막이식술후양막용해시간위( 12.833±2.483)d.3충방법양막이식술후양막용해시간차이유통계학의의(F=13.067,P＜0.00l),차각조간양막이식술후양막용해시간차이균유통계학의의,기중감입법양막이식술후양막용해시간최장,복개법양막이식술후양막용해시간최단；(3)HE염색가견전통방법양막이식수술중봉선부위유대량염성세포침윤,이무봉선양막이식중무명현염증반응；(4)양막용해후양막여각막융합적위치관계가분위삼충,즉양막위우각막상피표면、각막상피층간급각막기질간,차동일충양막이식방법중양막여각막융합적위치관계가이시이상3충위치관계중적일충혹다충동시존재,단차이무통계학의의(H=4.206,P=0.122).결론 양막용해후가존재우각막조직중,무봉선양막이식교전통양막이식방법수술시간단、염증반응경,재각막시로병변치료중구유경엄활적응용전경.
Objective Use three different methods of amniotic membrane transplantation for acute alkaline burn of rat cornea,to investigate the difference on operation time,reabsorption time of amniotic membrane,integration patterns of amniotic membrane into the cornea among the three amniotic membrane transplantation methods.Methods SD rats were randomly assigned into five groups.Group A: simply alkaline burn of cornea; Group B: inlay method; Group C: overlay method; Group D: sutureless method;Group E: normal.Prepared the model of corneal alkaline burn of the right eyes of group A-D rats,performed three different methods of amniotic membrane transplantation on Group B-D rats respectively within 24 hours after alkaline burn.The operation time was recorded.Observed the eyes with slit-lamp microscopy after transplantation,recorded the reabsorption time of amniotic membrane.HE staining and immmunohistochemical staining against human collagen Ⅳ were performed for pathological study.The results were analysed with Image-Pro Plus 6.0 software.The integration patterns of amniotic membrane into the cornea after amniotic membrane reabsorbed were observed.Results ( 1 ) Operation time: Group B was ( 35.500 ± 2.878 )minutes ; Group C was ( 33.375 ± 2.973 ) minutes ; Group D was (9.875 ± 1.246 ) minutes.There was statistical significance between group B and group D ( P ＜ 0.001 ),group C and group D ( P ＜ 0.001 ).There was no statistical significance between group B and group C (P =0.102).(2) Reabsorption time of amniotic membrane: Group B was (16.625 ±3.662) days; Group C was (9.250 ±2.188) days; Group D was ( 12.833 ± 2.483) days.There was statistical significance among group B,C,D ( P ＜ 0.001 ).(3)There was significant inflammatory reaction around the suture in Group B and Group C,and there was unconspicuous inflammatory reaction in Group D.(4) There were three integration patterns of amniotic membrane into the cornea after amniotic membrane reabsorption: superficial localization,intraepithelial and intrastromal.We could find one or more integration patterns in same method of amniotic membrane transplantation,there was no statistical significance among group B,C,D ( P =0.86 ).Conclusions Amniotic membrane can integrate into the cornea after amniotic membrane reabsorption.Sutureless amniotic membrane transplantation which has short operation time and unconspicuous inflammatory reaction is better than traditional amniotic membrane transplantation,and it will be used extensively in the ophthalmology field in future.
