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·临床报告·Medpor 下睑插片修复中重度下睑缺损的疗效观察李海燕,邵摇 娟,吕伯昌,张摇 华,田冰玉作者单位:(710004)中国陕西省西安市第四医院眼科作者简介:李海燕,硕士,主治医师,研究方向:眼睑病、青光眼、白内障。通讯作者:李海燕. lihaiyanry@163. com收稿日期: 2014-03-15 摇 摇 修回日期: 2014-07-07Clinical observation on the reconstructionof large areas lower eyelid defect withMedpor spacer graftHai-Yan Li, Juan Shao, Bo-Chang L俟, Hua Zhang,Bing-Yu TianDepartment of Ophthalmology, Xi爷 an No. 4 Hospital, Xi爷 an710004, Shaanxi Province, ChinaCorrespondence to:Hai-Yan Li. Department of Ophthalmology,Xi爷 an No. 4 Hospital, Xi爷 an 710004, Shaanxi Province, China.lihaiyanry@163. comReceived:2014-03-15摇 摇 Accepted:2014-07-07Abstract誗AIM: To observe the effects of porous polyethylene(Medpor) as a spacer graft in the reconstruction of largeareas eyelid defect after the operation of malignanttumors of lower eyelids.誗 METHODS: Nineteen cases (19 eyes) of malignanttumorsoflowereyelidreconstruction were selected. Medpor lower eyelid insertsimplantation were used to replace tarsal joint slidingconjunctival flap and pedicle flap, and repaired full -thickness lower eyelid defects then underwent eyelidreconstruction.誗 RESULTS:improvements were satisfactory with no stimulation onthe eyeball and no effect on the visual function. Implantsis with no absorption, shift, exclusion or infection and notumor recurrence in all cases during the follow up for6-36mo.誗implantation can instead tarsal plate for the reconstructionof medium to large areas lower eyelid defect, which iseasy performing with rare complications. It is an idealalternatives of tarsal plate.誗reconstruction; lower eyelid defectunderwenttheeyelidAppearanceofeyelidsandfunctionalCONCLUSION:MedporlowereyelidinsertsKEYWORDS:Medporlowereyelidinserts;Citation:Li HY, Shao J, L俟 BC, et al . Clinical observation on thereconstruction of large areas lower eyelid defect with Medpor spacergraft. Guoji Yanke Zazhi(Int Eye Sci) 2014;14(8):1537-1539摘要目的:观察下睑恶性肿瘤切除术后采用 Medpor 下睑插片植入在修复中重度下睑缺损中的效果。方法:选取下睑恶性肿瘤切除术后患者 19 例 19 眼,采用Medpor 下睑插片植入替代睑板联合滑行结膜瓣和带蒂皮瓣移植,修复下睑全层缺损行眼睑再造术。结果:眼睑外观修复及功能恢复满意,对眼球无刺激,对视功能无影响,术后随访 6 ~ 36mo,植入物无吸收、移位、排斥及感染,肿瘤无复发。结论:Medpor 下睑插片替代睑板植入修复中重度下睑缺损简便易行,术后并发症少,是一种理想的睑板替代物。关键词:Medpor 下睑插片;修复;下睑缺损DOI:10. 3980/ j. issn.1672-5123. 2014.08. 52引用:李海燕,邵娟,吕伯昌,等. Medpor 下睑插片修复中重度下睑缺损的疗效观察. 国际眼科杂志 2014;14(8):1537-15390 引言摇 摇 眼睑是眼球的保护屏障,其结构复杂,也是眼部恶性肿瘤好发的部位。 眼睑恶性肿瘤切除术后眼睑缺损,眼球失去自身的保护屏障,如何对术后眼睑缺损的修复对于眼球的保护意义重大。 如眼睑缺损范围较大,特别是眼睑后层组织的大范围缺损,常给修复带来困难。 Medpor 下睑插片是一种高密度多孔聚乙烯材料,大小 27mm伊16mm,厚度0. 45mm,白色,表面粗糙有较多微孔,孔径100滋m,微孔结构占总体积的 50%。 其强度随温度而改变,在常温下高硬度,在 82益 ~ 100益 变软,术中可根据眼睑缺损面积用外科剪刀或手术刀片切割修剪 Medpor 下睑插片,是一种良好的修复材料。 我们观察 2010-01/2013-04 我院收治的 19 例采用 Medpor 下睑插片替代睑板植入修复中重度下睑缺损病例的疗效,报告如下。1 对象和方法1.1 对象摇 选取 2010-01/2013-04 行下睑恶性肿瘤切除术后均为中重度下睑全层缺损者共 19 例,缺损范围长度:眼睑全长的 1/2 或以上。 其中男 8 例,女 11 例,平均年龄64 岁;症状为下睑新生物生长,下睑皮肤或睑板内可见隆起结节,无触痛,结节表面有溃烂、出血。 病理检查证实:眼睑基底细胞癌 11 例,睑板腺癌 4 例,鳞状细胞癌 2 例,恶性黑色素瘤 2 例。1.2 方法摇 采用美国 9546 型 Medpor 下睑插片修复下睑缺损。 术前常规消毒铺巾,局部浸润麻醉后,采用 Mohs 法控制肿瘤切除范围[1],在范围大于肿瘤 5mm 处行全层眼睑切除后,术中行快速冰冻切片确认切口边缘组织无癌细胞残留,再进一步行玉期眼睑修复术。 对于后层的眼睑缺损,根据眼睑缺损范围,将下穹隆部残余的睑结膜垂直滑行作为睑板后层的内衬,若下穹隆部残余结膜较少,可取上穹隆部结膜作为部分睑板后层的内衬,6-0 可吸收线间7351Int Eye Sci, Vol. 14, No. 8, Aug. 2014摇 摇Tel:029鄄82245172摇 82210956摇 摇 Email:IJO. 2000@163. comwww. ies. net. cn