CAJ | 학술논문

背景使用组织黏合剂对眼表损伤进行修复的临床疗效已得到证实,但是其对眼表环境的影响尚不清楚. 目的评价α-氰基丙烯酸正丁酯治疗皮肤、结膜裂伤的安全性和有效性. 方法 20只健康新西兰兔按随机数字表法随机分成医用胶组和缝线组,先行常规眼部检查,检测泪液分泌量和泪膜破裂时间(BUT).表面麻醉后全层剪开右眼上方球结膜,长1.0 cm;局部麻醉后全层切开背部皮肤,长约2.5 cm,医用胶组使用α-氰基丙烯酸正丁酯黏合结膜及皮肤切口,缝线组用5-0丝线连续缝合结膜及间断缝合皮肤切口,术后1、2、7d行常规检查并检测实验眼泪液分泌量及BUT,观察切口愈合情况.1周后处死动物,切取相应组织进行病理学检查.应用SPSS 13.0统计学软件进行统计分析. 结果医用胶组和缝线组结膜和皮肤切口均愈合良好.医用胶组术后1d、2d的泪液分泌量分别为(12.70±2.21)mm和(12.70±2.00)mm,明显低于缝线组的(14.90±2.38) mm和(14.90±2.33)mm,相同时间点2个组间比较差异均有统计学意义(q=-4.02,P=0.03;q=-4.02,P=0.03)；与基线值相比,医用胶组术后各时间点的泪液分泌量差异均无统计学意义(P=1.00、1.00、0.51).医用胶组术后2d、7d的BUT值分别为(4.50±1.18)s和(4.10±0.88)s,均明显长于缝线组的(3.30±1.06)s和(3.00±1.25)s,差异均有统计学意义(q=4.37,P=0.02;q=4.19,P=0.03)；术后1、2、7d的BUT值与基线值相比差异均无统计学意义(P=0.28、0.59、0.21).缝线组各时间点BUT值较基线值明显缩短,差异均有统计学意义(P=0.01、0.01、0.00).角膜组织病理学检查发现,各组兔结膜及皮肤切口均愈合,缝线组结膜组织有轻度胶原增生,而医用胶组炎性细胞浸润更为明显；缝线组皮肤表皮瘢痕增生,存在严重的胶原纤维增生,而医用胶组胶原增生情况明显轻于缝线组,表皮及真皮等组织结构接近正常. 结论 α-氰基丙烯酸正丁酯用于新西兰兔结膜和皮肤伤口的黏合对眼表的环境影响较小,有效性和安全性较好. 揹景使用組織黏閤劑對眼錶損傷進行脩複的臨床療效已得到證實,但是其對眼錶環境的影響尚不清楚. 目的評價α-氰基丙烯痠正丁酯治療皮膚、結膜裂傷的安全性和有效性. 方法 20隻健康新西蘭兔按隨機數字錶法隨機分成醫用膠組和縫線組,先行常規眼部檢查,檢測淚液分泌量和淚膜破裂時間(BUT).錶麵痳醉後全層剪開右眼上方毬結膜,長1.0 cm;跼部痳醉後全層切開揹部皮膚,長約2.5 cm,醫用膠組使用α-氰基丙烯痠正丁酯黏閤結膜及皮膚切口,縫線組用5-0絲線連續縫閤結膜及間斷縫閤皮膚切口,術後1、2、7d行常規檢查併檢測實驗眼淚液分泌量及BUT,觀察切口愈閤情況.1週後處死動物,切取相應組織進行病理學檢查.應用SPSS 13.0統計學軟件進行統計分析. 結果醫用膠組和縫線組結膜和皮膚切口均愈閤良好.醫用膠組術後1d、2d的淚液分泌量分彆為(12.70±2.21)mm和(12.70±2.00)mm,明顯低于縫線組的(14.90±2.38) mm和(14.90±2.33)mm,相同時間點2箇組間比較差異均有統計學意義(q=-4.02,P=0.03;q=-4.02,P=0.03)；與基線值相比,醫用膠組術後各時間點的淚液分泌量差異均無統計學意義(P=1.00、1.00、0.51).醫用膠組術後2d、7d的BUT值分彆為(4.50±1.18)s和(4.10±0.88)s,均明顯長于縫線組的(3.30±1.06)s和(3.00±1.25)s,差異均有統計學意義(q=4.37,P=0.02;q=4.19,P=0.03)；術後1、2、7d的BUT值與基線值相比差異均無統計學意義(P=0.28、0.59、0.21).縫線組各時間點BUT值較基線值明顯縮短,差異均有統計學意義(P=0.01、0.01、0.00).角膜組織病理學檢查髮現,各組兔結膜及皮膚切口均愈閤,縫線組結膜組織有輕度膠原增生,而醫用膠組炎性細胞浸潤更為明顯；縫線組皮膚錶皮瘢痕增生,存在嚴重的膠原纖維增生,而醫用膠組膠原增生情況明顯輕于縫線組,錶皮及真皮等組織結構接近正常. 結論 α-氰基丙烯痠正丁酯用于新西蘭兔結膜和皮膚傷口的黏閤對眼錶的環境影響較小,有效性和安全性較好.
배경 사용조직점합제대안표손상진행수복적림상료효이득도증실,단시기대안표배경적영향상불청초. 목적 평개α-청기병희산정정지치료피부、결막렬상적안전성화유효성. 방법 20지건강신서란토안수궤수자표법수궤분성의용효조화봉선조,선행상규안부검사,검측루액분비량화루막파렬시간(BUT).표면마취후전층전개우안상방구결막,장1.0 cm;국부마취후전층절개배부피부,장약2.5 cm,의용효조사용α-청기병희산정정지점합결막급피부절구,봉선조용5-0사선련속봉합결막급간단봉합피부절구,술후1、2、7d행상규검사병검측실험안루액분비량급BUT,관찰절구유합정황.1주후처사동물,절취상응조직진행병이학검사.응용SPSS 13.0통계학연건진행통계분석. 결과 의용효조화봉선조결막화피부절구균유합량호.의용효조술후1d、2d적루액분비량분별위(12.70±2.21)mm화(12.70±2.00)mm,명현저우봉선조적(14.90±2.38) mm화(14.90±2.33)mm,상동시간점2개조간비교차이균유통계학의의(q=-4.02,P=0.03;q=-4.02,P=0.03)；여기선치상비,의용효조술후각시간점적루액분비량차이균무통계학의의(P=1.00、1.00、0.51).의용효조술후2d、7d적BUT치분별위(4.50±1.18)s화(4.10±0.88)s,균명현장우봉선조적(3.30±1.06)s화(3.00±1.25)s,차이균유통계학의의(q=4.37,P=0.02;q=4.19,P=0.03)；술후1、2、7d적BUT치여기선치상비차이균무통계학의의(P=0.28、0.59、0.21).봉선조각시간점BUT치교기선치명현축단,차이균유통계학의의(P=0.01、0.01、0.00).각막조직병이학검사발현,각조토결막급피부절구균유합,봉선조결막조직유경도효원증생,이의용효조염성세포침윤경위명현；봉선조피부표피반흔증생,존재엄중적효원섬유증생,이의용효조효원증생정황명현경우봉선조,표피급진피등조직결구접근정상. 결론 α-청기병희산정정지용우신서란토결막화피부상구적점합대안표적배경영향교소,유효성화안전성교호.
Background The effectiveness of medical tissue adhesive for the reparation of operative incision has been recognized,but its influence to ocular surface microenvironment is not quite clear.Objective This study was to appraise the safety and efficacy of α-cyanoacrylate,a medical issue adhesive,for the reparation of the conjunctival and skin laceration.Methods Twenty healthy New Zealand rabbits were randomly divided into suturing group and medical glue group.Routine ophthalmic examination,the level of tear secretion and breakup time of tear film (BUT) were tested before operation.The upper bulbar conjunctiva of each right eye was cut apart about 1.0 cm after surface anesthesia and the skin of back was incised about 2.5 cm length after local anesthesia.The conjunctival and skin lacerations were adhered with compound medical adhesive in the medical glue group,and continuous suture was done to repair the conjunctival laceration and interrupted suture to the skin laceration with 5-0 chorda serica chirurgicalis in the suture group.The routine ophthalmic examination,level of tear secretion,BUT and the states of wound healing were examined 1 day,2 days and 7 days postoperatively.Pathologic examination of the corresponding tissues was also carried out 1 week after the animals were sacrificed.The data were analyzed by SPSS 13.0 statistical software.This experiment followed the Administration of the Care and Use of Experimental Animals of Shanghai City.Results The conjunctival and skin lacerations healed well both in the suture group and the medical glue group.The levels of tear secretion 1 day and 2 days postoperatively in the medical glue group were (12.70±2.21)mm and (12.70±2.00)mm respectively,showing a significant lowness in comparison with (14.90±2.38)mm and (14.90±2.33)mm of the suture group (q =-4.02,P =0.03;q =-4.02,P =0.03).Compared with the baseline,the difference of the levels of tear secretion in the medical glue group was not statistically significant in various time points after operation (P=1.00,1.00,0.51).The BUT values at 2 days and 7 days postoperatively in the medical glue group were (4.50 ± 1.18) seconds and (4.10±0.88) seconds respectively,being significantly longer than (3.30 ± 1.06) seconds and (3.00±1.25) seconds in the suture group (q=4.37,P=0.02;q=4.19,P=0.03).Compared with the baseline,there was not statistically significant difference at each time point postoperatively in the medical glue group (P =0.28,0.59,0.21).However,BUT at each time point after operation in the suture group was significantly shorter than that of the baseline (P=0.01,0.01,0.00).Pathological examination showed that all the conjunctival and skin lacerations healed well.Trivial collagen hyperplasy was seen in the eyes of the suture group and infiltration of a few of inflammatory cells was found in the medical glue group.In the pathological result of the skin test,there was conspicuous scar and severe collagen hyperplasy in the suture group,but in the medical glue group,the skin structure was almost normal.Conclusions α-Cyanoacrylate is safe and effective for the repair of the conjunctival incision with little affection to ocular surface microenvironment.