發(fā)布時(shí)間：2019-03-27 19:30

【摘要】：目的：探討應(yīng)用顳區(qū)預(yù)構(gòu)復(fù)合組織瓣的治療方法修復(fù)各種原因所引起的全眼瞼及周圍組織缺損。 背景：眼瞼本身的解剖結(jié)構(gòu)復(fù)雜,眼瞼重建包括前層重建(皮膚和眼輪匝肌)和后層重建(瞼板和瞼結(jié)膜)。因外傷、腫瘤切除以致全眼瞼及周圍組織缺損行全眼瞼再造一直是臨床上的一大難題。隨著近幾年發(fā)展,復(fù)合組織轉(zhuǎn)移修復(fù)的新方法已經(jīng)越來(lái)越多的應(yīng)用在治療部分眼瞼缺損中,軟組織擴(kuò)張器及預(yù)構(gòu)皮瓣的方法在整形外科中的廣泛應(yīng)用,同時(shí),眼輪匝肌蒂顳區(qū)皮瓣在尸體解剖及臨床應(yīng)用中的研究,臨床應(yīng)用廣泛,手術(shù)效果確實(shí)。因此,將這幾種方法結(jié)合以復(fù)合組織重建眼瞼后層結(jié)合以眼輪匝肌為蒂的顳區(qū)擴(kuò)張皮瓣預(yù)構(gòu)眼瞼的方法應(yīng)用在治療全眼瞼及周圍組織缺損中。 方法：一期手術(shù)于顳區(qū)埋置擴(kuò)張器形成擴(kuò)張皮瓣,二期手術(shù)于擴(kuò)張皮瓣下植入口腔黏膜及耳軟骨形成預(yù)構(gòu)的復(fù)合組織瓣,三期手術(shù)行以眼輪匝肌為蒂的復(fù)合組織瓣全眼瞼再造術(shù)。同時(shí),以相似的方法用于動(dòng)物實(shí)驗(yàn)上探索應(yīng)用擴(kuò)張皮瓣下預(yù)制口腔粘膜及耳軟骨再造眼瞼結(jié)構(gòu)的可行性。同時(shí)進(jìn)行自身對(duì)照進(jìn)一步證實(shí)復(fù)合組織的成活條件,以及后期軟骨吸收的情況及粘膜攣縮的程度。 結(jié)果：自2010年6月至2011年11月共入組3例外傷導(dǎo)致全眼瞼及周圍組織缺損的患者,均接受應(yīng)用顳區(qū)預(yù)構(gòu)復(fù)合組織瓣的治療方法,均取得較為滿意的手術(shù)效果。經(jīng)1年的臨床隨訪再造眼瞼的粘膜及軟骨成活良好�；颊邔�(duì)術(shù)后義眼的佩戴效果較為滿意。動(dòng)物實(shí)驗(yàn)表明復(fù)合組織中,耳軟骨進(jìn)行適當(dāng)?shù)男藜艏按蚩滋幚砀谕鈱涌谇火つさ某苫睢?結(jié)論：應(yīng)用顳區(qū)預(yù)構(gòu)復(fù)合組織瓣的治療方法修復(fù)全眼瞼及周圍組織缺損與其他手術(shù)方式相比,再造眼瞼更接近正常眼瞼的結(jié)構(gòu),同時(shí)結(jié)合擴(kuò)張皮瓣解決了全眼瞼及周圍組織缺損供區(qū)組織量不足的情況,手術(shù)效果好,為全眼瞼的再造開(kāi)辟了新的途徑。
[Abstract]:Objective: to investigate the treatment of total eyelid and surrounding tissue defects caused by various causes by using temporal prefabricated composite tissue flap. Background: the anatomical structure of eyelid itself is complex. Blepharoplasty includes anterior layer reconstruction (skin and orbicularis oculi muscle) and posterior layer reconstruction (palpebral plate and eyelid conjunctiva). Total eyelid reconstruction due to trauma, tumor resection and defects of eyelids and surrounding tissues has been a major clinical problem. With the development of recent years, the new method of compound tissue transfer repair has been more and more used in the treatment of partial eyelid defect, soft tissue expander and prefabricated flap are widely used in plastic surgery, at the same time, The temporal flap pedicled with orbicularis oculi muscle is widely used in autopsy and clinical application. Therefore, these methods combined with compound tissue reconstruction of eyelid posterior layer combined with expanded temporal flap pedicled with orbicularis oculi muscle were applied to the treatment of total eyelid and surrounding tissue defects. Methods: the expanded skin flap was formed by embedding the expander in the temporal region in the first stage, and the oral mucosa and auricular cartilage were implanted under the expanded flap in the second stage to form the preformed composite tissue flap. The third stage operation was performed with compound tissue flap pedicled with orbicularis oculi muscle. At the same time, a similar method was used to explore the feasibility of reconstruction of eyelid structure by prefabricated oral mucosa and auricular cartilage under expanded flap in animal experiments. At the same time, the survival condition of compound tissue, the condition of cartilage absorption and the degree of mucosal contracture were further confirmed by self-control. Results: from June 2010 to November 2011, 3 cases of total eyelid and surrounding tissue defect caused by trauma were treated with temporal region prefabricated compound tissue flap, and satisfactory results were obtained. After 1 year clinical follow-up, the mucosa and cartilage of eyelid reconstruction survived well. The patients were satisfied with the wearing effect of the artificial eye after operation. Animal experiments showed that proper pruning and perforating of auricular cartilage were more favorable for the survival of outer oral mucosa. Conclusion: compared with other surgical methods, the reconstruction of eyelid is closer to the structure of normal eyelid by using temporal region prefabricated compound tissue flap to repair the total eyelid and surrounding tissue defect, and the results show that the reconstruction of eyelid is more similar to that of normal eyelid. At the same time, combined with the expanded flap, the insufficient amount of tissue in the donor area of the whole eyelid and surrounding tissue defect was solved. The result of the operation was good, which opened up a new way for the reconstruction of the whole eyelid.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R779.6

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