带环形板层巩膜瓣全角膜移植术临床及免疫学探讨.docVIP

???? 带环形板层巩膜瓣全角膜移植术?临床及免疫学探讨 ???? ????　【摘要】　目的　观察带环形板层巩膜瓣全角膜移植术(total cornea with circle lameller sclera transplantation,CST)的临床疗效，结合动物实验探讨其免疫学机制。方法　对109例（109只眼）行角膜移植术的患者进行回顾性分析，按术式进行分组。比较手术后不同时期的排斥率及角膜新生血管出现的时间。动物实验分组及方法同临床。结果　带环形板层巩膜瓣全角膜移植术组，角膜植片新生血管出现时间及排斥发生时间较全角膜移植术(total cornea transplantation,TCT)组延迟，而较部分穿透性角膜移植术(penetrating keratoplasty,PKP)组3～6个月时的排斥率明显增加。结论　带环形板层巩膜瓣全角膜移植术是眼前节重建的重要方法，其免疫学机制复杂，而完整的异体角巩膜缘在免疫反应中占重要地位。　　【关键词】　移植物排斥　　角膜缘 Clinical and immunological studies on transplantationof total cornea with circular lamellar sclera YANG Chaozhong, JIANG Guomin, SUN Lixia.Department of Ophthalmology, Second Affiliated Hospital, Qingdao Medical College, Qingdao 266042 　　【Abstract】　Objective　To observe the clinical results of total cornea with circular lamellar sclera transplantation (CST) and study its immunological mechanisms by animal experiments. Methods　109 patients with corneal transplantation were retrospectively analyzed, and according to the methods of operation they were divided into groups to compare their rate of rejection and the time of occurrence of corneal neovascularization. The methods of grouping and operation in animal experiments were similar to that in the clinical practice. Results　The time of occurrence of neovascularization and rejection of CST were later than that in the total corneal transplantation (TCT), and the postoperative rate of rejection at 3 to 6 months was obviously increased in comparison with that in the partial penetrating keratoplasty (PKP). Conclusion　CST is an important method for rebuilding ocular anterior segment, and the donor limbus is active in the immunological of rejection.　　【Key words】　Graft rejection　　Limbus cornea 　　眼前节重建术是治疗严重角膜疾病的主要措施，而重建术方法各异，我们对1993～1997年间109例行角膜移植术患者进行回顾性分析，结合动物实验，对带环形板层巩膜瓣全角膜移植术(total cornea with circle lameller sclera transplantation, CST)的免疫反应及临床效果进行分析，现报告如下。 资料与方法 　　一、对象 　　选择本院109例(109只眼)行角膜移植术住院患者。按手术方式分组：Ⅰ组：CST 26例，男20例，女6例；平均年龄41岁。Ⅱ组：全角膜移植术(total cornea transplantation, TCT)7