Güerrissi Jorge Orlando, Belmonte Javier
Department of Plastic Surgery, Cosme Argerich Hospital, Buenos Aires, Argentina.
J Craniofac Surg. 2004 Jan;15(1):6-10. doi: 10.1097/00001665-200401000-00004.
Despite the availability of efficient tear substitutes, many patients with dry eye syndrome experience severe corneal injuries and a subsequent loss of vision. Surgical techniques using mayor salivary glands to provide a substitute for tears have been reported; with this technique the drainage of saliva goes into the conjunctival fornix, permitting corneal and conjunctival humidification. The authors describe a new surgical approach in which minor salivary glands are autotransplanted into the conjunctival fornix by means of a graft of the intraoral mucosa-transporting salivary glands. This approach was used in a 56-year-old woman with a 2-year history of refractory and pharmacologically untreatable dry eye syndrome caused by Sjögren's syndrome. The right eye had more severe corneal and conjunctival lesions than did the contralateral one, so the treatment was planned in the right eye only. A weekly follow-up during the first 6 months confirmed the significant improvement of dry eye symptoms in the surgically treated eye. Three months after surgery, a biopsy was performed in the minor salivary gland graft, and the histologic findings revealed the presence of glandular acinus, duct with mucin content, and lymphocyte infiltration. The significant improvement obtained in this patient suggests that the secretion from the grafted salivary minor glands was better in promoting homeostasis of the ocular surface than are artificial tears. This may be explained by: (1) The lacrimal and salivary secretions contain biologically active constituents that may protect from infection and promote normal growth epithelium; (2) The secreted mucin is thought to coat the epithelial surface, reducing the high surface tension of the eye wetted by aqueous tears; (3) The thick secretions of the minor gland might act in reducing the evaporation of the underlying tear layer and form a hydrophobic barrier along the lid margin that can retain the lid margin tear string and prevent its flow onto the skin. Minor gland salivary autotransplant is a new surgical technique with effectiveness demonstrated in one patient, but the scientific explanation is not clear; additional experience with more cases could confirm the initial success.
尽管有高效的泪液替代品，但许多干眼症综合征患者仍会经历严重的角膜损伤并随后丧失视力。已有报道使用大唾液腺的手术技术来替代泪液；采用这种技术，唾液引流至结膜穹窿，可使角膜和结膜保持湿润。作者描述了一种新的手术方法，即通过移植含唾液腺的口腔黏膜将小唾液腺自体移植到结膜穹窿。该方法应用于一名56岁女性，她患有由干燥综合征引起的难治性且药物治疗无效的干眼症综合征达2年。右眼的角膜和结膜病变比左眼更严重，因此仅对右眼进行治疗。在最初的6个月中每周进行随访，证实手术治疗眼的干眼症状有显著改善。术后3个月，对小唾液腺移植物进行活检，组织学检查结果显示存在腺泡、含黏蛋白的导管以及淋巴细胞浸润。该患者取得的显著改善表明，移植的小唾液腺分泌液在促进眼表稳态方面比人工泪液更好。这可能是由于：（1）泪液和唾液分泌液含有生物活性成分，可能有助于预防感染并促进上皮正常生长；（2）分泌的黏蛋白被认为可覆盖上皮表面，降低被水性泪液湿润的眼的高表面张力；（3）小唾液腺的浓稠分泌物可能有助于减少下方泪液层的蒸发，并沿睑缘形成疏水屏障，可留住睑缘泪液线并防止其流到皮肤上。小唾液腺自体移植是一种新的手术技术，在一名患者中已证明有效，但科学解释尚不清楚；更多病例的额外经验可能会证实最初的成功。
