Yu Guangyan, Zhu Zhenghong, Mao Chi, Cai Zhigang, Zou Liuhe, Lü Lan
Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing 100081, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2002 Sep;37(5):353-5.
To summarize operation key points, prevention and management of complications in vascularized autotransplantation of submandibular gland for treatment of severe keratoconjunctivitis sicca.
23 patients with severe keratoconjunctivitis sicca were treated by this procedure. Postoperative (99m)Tc images, follow-up studies, and management of complications were performed.
The transplantations were successful in 19 cases, whose symptoms of xerophthalmia disappeared. The patients could stop applying artificial tears. In 4 patients the transplanted glands did not survive. Epiphora occurred in 5 cases. They were successfully treated by reducing the size of the graft. Obstruction of the Wharton's duct took place in one case and was treated by reconstructing the duct. When the superficial temporal vein was too small, venous bridging was applied. To select a relevant vein for anastomosis, blood oozing from the three veins was carefully inspected prior cutting off the gland when the external maxillary artery was preserved and was infused with heparin after the gland had been freed.
If every point has been properly managed, the successful rate of operation could be warranted.
总结带血管蒂自体下颌下腺移植治疗重度干燥性角结膜炎的手术要点、并发症的预防及处理。
应用该手术方法治疗23例重度干燥性角结膜炎患者。术后进行（99m）Tc显像、随访及并发症处理。
19例移植成功，干眼症状消失，患者可停用人工泪液。4例移植腺体未存活。5例发生溢泪，经缩小移植腺体体积后治愈。1例发生颌下腺导管阻塞，经导管重建治愈。当颞浅静脉过细时，采用静脉搭桥。在保留面动脉的情况下，切断腺体前仔细观察面动脉、面前静脉及面后静脉的渗血情况，选择合适的静脉进行吻合；腺体游离后，向腺体注入肝素。
手术各环节处理得当，可保证手术成功率。
