甲状腺相关性眼病上睑退缩的治疗

发布时间：2018-03-13 11:29

本文选题：上睑退缩　切入点：甲状腺相关性眼病　出处：《上海医学》2017年07期 　论文类型：期刊论文

【摘要】：目的探讨甲状腺相关性眼病(TAO)上睑退缩的治疗方法。方法回顾分析临床资料完整的55例72眼TAO上睑退缩患者的治疗效果。分别采用上睑局部注射A型肉毒杆菌毒素、Müller肌切除术联合提上睑肌部分切断术、提上睑肌-Müller肌延长术治疗TAO上睑退缩。活动期或病情稳定时间6个月的静止期患者采用上睑注射A型肉毒杆菌毒素治疗;病情稳定时间6个月的静止期患者中,轻度和中度上睑退缩者采用Müller肌切除术联合提上睑肌部分切断术治疗,中度和重度上睑退缩者采用提上睑肌-Müller肌延长术治疗。术毕以轻度过矫为宜。结果上睑局部注射A型肉毒杆菌毒素治疗12例15眼,治疗后上睑退缩完全消失4例5眼,明显改善7例8眼,无效1例2眼,治疗有效率为86.7%(13/15)。Müller肌切除术联合提上睑肌部分切断术治疗32例43眼,治疗后上睑退缩完全消失16例23眼,明显改善11例15眼,无效5例5眼,治疗有效率为88.4%(38/43)。提上睑肌-Müller肌延长术治疗11例14眼,治疗后上睑退缩完全消失7例9眼,明显改善2例3眼,无效2例2眼,治疗有效率为85.7%(12/14)。3种治疗方法间治疗有效率的差异均无统计学意义(P值均0.05)。上睑注射A型肉毒杆菌毒素治疗后欠矫1例2眼;Müller肌切除术联合提上睑肌部分切断术治疗后欠矫3例3眼,轻度过矫2例2眼;提上睑肌-Müller肌延长术后欠矫1例1眼,轻度过矫1例1眼。结论 TAO上睑退缩宜采用综合治疗措施。A型肉毒杆菌毒素治疗适用于活动期患者、眼局部应用人工泪液和眼膏难以缓解症状者;病情稳定时间6个月的静止期患者,可手术治疗。
[Abstract]:Objective to investigate the treatment of upper eyelid retraction in patients with thyroid associated ophthalmopathy (TAO). Methods 55 cases (72 eyes) with TAO upper eyelid retraction with complete clinical data were retrospectively analyzed. Botulinum toxin type A was injected locally into the upper eyelid. M 眉 ller myectomy combined with partial levator blepharotomy, Levator palpebral muscle-M 眉 ller muscle lengthening was performed for the treatment of TAO upper eyelid retraction. Patients with active or stable condition at rest for 6 months were treated with Botulinum toxin A injection into the upper eyelid. Patients with mild or moderate upper eyelid retraction were treated by M 眉 ller myectomy combined with partial levator blepharotomy. The patients with moderate and severe upper eyelid retraction were treated with levator palpebral muscle M 眉 ller muscle lengthening, and mild overcorrection was performed at the end of the operation. Results Local injection of botulinum toxin A was used in 15 eyes of 12 cases and 5 eyes of 4 cases with complete disappearance of upper eyelid retraction after treatment. The effective rate was 86.7%. The effective rate was 86.7%. M 眉 ller myectomy combined with partial levator blepharotomy was used to treat 32 cases (43 eyes), 16 cases (23 eyes) disappeared completely after treatment, 11 cases (15 eyes) improved obviously, 5 cases (5 eyes) had no effect. The effective rate of treatment was 88.4% 38 / 43. The extension of levator palpebral muscle M 眉 ller muscle was performed in 14 eyes of 11 cases, 7 cases of 9 eyes disappeared completely after treatment, 2 cases 3 eyes improved obviously, 2 cases 2 eyes failed, 2 cases 2 eyes. The effective rate of treatment was 85.7 / 14.3. There was no significant difference in the effective rate of treatment among 12 / 14.3 treatments (P = 0.05). Under correction after upper eyelid injection of botulinum toxin A, 2 eyes of 1 case were treated with myectomy of M 眉 ller combined with partial resection of levator palpebri muscle. 3 cases (3 eyes) were undercorrected after treatment. There were 2 eyes with mild overcorrection, 1 case with undercorrection of levator muscle M 眉 ller muscle and 1 eye with mild overcorrection. Conclusion TAO upper eyelid retraction should be treated with botulinum toxin type A. Artificial tears and ointment were difficult to relieve the symptoms, and patients with stable condition for 6 months could be treated surgically.
【作者单位】：上海长征医院眼科;
【基金】：国家自然科学基金委员会青年科学基金资助项目(81400432)
【分类号】：R581;R771.3

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