保留悬吊系统的提上睑肌缩短术矫正先天性上睑下垂

发布时间：2019-01-09 06:56

【摘要】：目的:介绍一种保留悬吊系统的提上睑肌缩短术矫正先天性上睑下垂的手术技术,为上睑下垂寻求更佳的手术方法,并达到功能和美学的双重效果。资料与方法:研究吉大二院眼科医院自2014年10月至2016年4月先天性上睑下垂患者90例(132只眼),其中轻度10例(14只眼),中度50例(68只眼),重度30例(50只眼)。术前行提上睑肌肌力、睑裂高度以及下垂程度等上睑下垂相关检查,排除手术禁忌,由重睑切口入路单纯从结膜固有层面分离Müller’s肌和提上睑肌复合组织瓣至合适位置,术中采取保留提上睑肌悬吊系统,然后将复合组织瓣相应位置与睑板上1/3位置固定缝合,术中每矫正1mm的下垂量缩短提上睑肌2-3mm。术后随访1周、1个月、6个月,观察术后上睑缘高度、眼睑形态、眼睑闭合程度、双眼对称性以及暴露性角膜炎的发生情况及患者满意度。结果:术后1周,所有患者眼睑肿胀基本消失,上睑缘位于上方角膜缘下0-2mm。轻、中度上睑下垂患者眼睑闭合良好,重度患者眼睑闭合有不同程度巩膜暴露度。术后1月,轻、中度患者上睑缘位置保持良好,位于角膜缘下方1-2mm,眼睑均能基本闭合完全。部分重度患者上睑缘高度稍有下降,但眼睑闭合程度较前明显改善。随访至6个月,轻、中度患者上睑缘位置仍稳定在角膜缘下1-2mm,眼睑均闭合自如。重度患者中,18例患者(34只眼)上睑缘位于角膜缘下1-2mm,12例患者(16只眼)位于角膜缘下2-4mm。大多数重度患者达到1至2度闭合,4例患者3度闭合。随访期间,无一例暴露性角膜炎发生,眼睑饱满,睑缘弧度良好,双眼对称或基本对称,患者满意度高。结论:保留悬吊系统的提上睑肌缩短术不破坏眼睑重要的解剖结构,节省提上睑肌缩短量,不仅手术损伤小,而且术后眼睑闭眼功能及形态恢复好,特别对于轻、中度上睑下垂可以达到最佳术后效果。
[Abstract]:Objective: to introduce a surgical technique of levator muscle shortening to correct congenital ptosis with suspending system, and to find a better operative method for blepharoptosis, and to achieve the dual effect of function and aesthetics. Materials and methods: from October 2014 to April 2016, 90 patients (132 eyes) with congenital blepharoptosis were studied, including 10 mild cases (14 eyes), 50 moderate cases (68 eyes) and 30 severe cases (50 eyes). The muscle strength of levator palpebrae muscle, the height of palpebral fissure and the degree of ptosis were examined before operation, and the surgical contraindication was eliminated. M 眉 ller's muscle and levator palpebral muscle composite tissue flap were separated from conjunctival inherent layer to proper position by double eyelid incision approach. The suspension system of levator palpebrae muscle was preserved during the operation, then the corresponding position of the composite tissue flap was fixed and sutured with the position of 1 / 3 of the upper eyelid plate. The sagging amount of 1mm was shortened by 2 to 3 mm. for each correction of 1mm during the operation. All patients were followed up for 1 week, 1 month and 6 months. The height of upper eyelid, the shape of eyelid, the degree of eyelid closure, the symmetry of both eyes, the occurrence of exposed keratitis and the satisfaction of the patients were observed. Results: at 1 week after operation, eyelid swelling disappeared in all patients, and the upper eyelid limbus was located 0-2 mm below the upper limbus cornea. Patients with mild and moderate blepharoptosis had good eyelid closure and severe blepharoptosis had different degree of scleral exposure. At 1 month after operation, the upper palpebral margin of mild and moderate patients remained well, 1-2 mm below the limbus cornea, and the eyelids were almost completely closed. In some severe patients, the height of upper eyelid edge decreased slightly, but the degree of eyelid closure was improved obviously. Follow-up to 6 months showed that the upper palpebral margin remained stable at 1-2 mm below the corneal limbus in mild and moderate patients, and the eyelids were closed freely. Of the 18 patients (34 eyes), the upper eyelid limbus was located at 1-2mm below the limbus cornea. 12 patients (16 eyes) were located 2-4 mm below the limbus cornea. Most severe patients had 1 to 2 degree closure and 4 patients had 3 degree closure. During the follow-up, no exposed keratitis occurred, the eyelid was full, the margin of eyelid was good, the eyes were symmetrical or basically symmetrical, and the satisfaction of the patients was high. Conclusion: the levator muscle shortening with suspension system does not destroy the important anatomical structure of eyelid, save the shortening of levator palpebral muscle, not only has little operation injury, but also the function and shape of eyelid closure after operation, especially for light. Moderate blepharoptosis can achieve the best postoperative effect.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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