不同类型眼袋术式的选择以及术后疗效的调查分析

发布时间：2018-04-10 17:23

  本文选题：眼袋分型 + 手术方式选择　； 参考：《浙江大学》2010年硕士论文

【摘要】： 背景与目的 眼袋是为眶脂肪与下睑支持结构之间失衡,具体说就是下睑皮肤,皮下组织,肌肉及眶膈松弛,眶后脂肪肥大,向前突出而呈囊袋状。手术行眼袋整复术是临床上去除眼袋、恢复外形美观的较好且彻底的手段。随着人们对自己外在的要求的提高,越来越多的患者希望通过整形手术来达到去除眼袋的目的。 不同的患者形成的眼袋表现各有不同,有其不同的局部病理解剖类型特点,需进行不同类型的手术。本文把眼袋为5种不同的类型：单纯眼轮匝肌肥大型、单纯皮肤松驰型、单纯眶脂肪疝出不伴皮肤松弛型、下睑膨隆伴皮肤松弛型和皮肤松弛伴眶下缘凹陷型。而同时又有三种手术方式：经结膜入路眼袋整复术、传统的皮肤入路眼袋整复术以及Hamra术式,其中传统的皮肤入路又分为皮瓣法与肌皮瓣法。 我科留有多数来科诊治的患者的资料,通过收集并统计我科2005年2月至2010年2月共5年内进行眼袋整复的患者的病例,对其查体、手术方式进行收集分析,并回访其是否出现并发症,目前手术效果如何等。主要对单纯脂肪膨出、脂肪膨出伴皮肤松弛及皮肤松弛伴下眶缘凹陷三类患者进行分析,以求找到针对各种不同类型的眼袋,其最有效且合适的外科治疗方法。 研究方法 收集并统计我科2005年2月至2010年2月共5年内进行眼袋整复的患者的病例。在此期间,一共有84位计168侧眼袋患者在我科接受过治疗,年龄范围为20—60岁,平均年龄49.8岁。其中29人共58侧单纯眶脂肪疝出眼袋患者,有39人共78侧下睑膨隆伴皮肤松弛型眼袋患者,有26人共52侧皮肤松弛伴眶下缘凹陷型眼袋患者。平均随访时间24.5个月。获得查体、手术方式、术后效果、并发症等多方面资料,研究分析各种不同类型眼袋整复术的特点。 结果 1结膜入路眶隔后及眶隔前入路手术效果未见显著性差异。 2行结膜入路切口≥1 cm时,应于内、中、外三点定位缝合结膜下组织,以利于创口对合生长。 3中重度下睑松弛的患者,行眼袋整复术时皮瓣法术后效果优于肌皮瓣法。 4对于重度下睑松弛患者,处理外眦是非常必要的,可以减少术后下睑外翻、下睑退缩的发生率。 5对于有眶下缘凹陷的患者,行Hamra术对于预防术后眶下缘凹陷有意义。 结论 对不同的眼袋类型,必须仔细进行术前评估,选择其最适合的手术方式,才能达到最佳手术效果,最大程度地减少手术并发症。
[Abstract]:Background and purposeThe pouch is an imbalance between the orbital fat and the lower eyelid supporting structure, specifically, the lower eyelid skin, subcutaneous tissue, muscle and orbital diaphragm are relaxed, and the postorbital fat is hypertrophic, protruding forward and presenting as a sachelike.The operation of pouch reduction is a good and thorough method to remove the pouch and restore the appearance.With the improvement of external requirements, more and more patients hope to remove pouch through plastic surgery.Different patients have different manifestations of pouch, have different characteristics of local pathological anatomy, and need different types of surgery.In this paper, there are five different types of pouch: simple orbicularis oculi muscle fat, simple skin relaxation, simple orbital fat hernia without skin relaxation, lower eyelid swelling with skin relaxation and skin relaxation with lower orbital depression.At the same time, there are three types of operation: transconjunctival pouch reduction, traditional skin pouch reduction and Hamra operation, among which the traditional skin approach is divided into flaps and musculocutaneous flaps.The data of the majority of patients treated in our department were collected and analyzed by collecting and counting the cases of the patients who underwent pouch reduction in 5 years from February 2005 to February 2010, and collecting and analyzing their physical examination and operation methods.And visit back to see if there are complications, the current results of surgery and so on.In order to find out the most effective and suitable surgical treatment for different types of pouch, three kinds of patients were analyzed, which were simple fat exophthalmos, fat exudation with skin relaxation and skin relaxation with lower orbital margin depression.Research methodTo collect and count the cases of pouch reduction in our department from Feb 2005 to Feb 2010.During this period, a total of 84 patients with 168 pairs of pouch were treated in our department, ranging in age from 20 to 60 years, with an average age of 49.8 years.There were 58 cases of simple orbital fat herniation in 29 cases, 78 cases of lower eyelid distention with skin relaxation pouch in 39 cases, and 52 cases of skin flabby with depressed orbital lower margin pouch in 26 cases.The mean follow-up time was 24.5 months.The characteristics of different types of pouch prosthesis were studied and analyzed, including physical examination, surgical methods, postoperative results and complications.Result1 there was no significant difference in the results of operation between the orbital septum and the anterior orbital septum via conjunctival approach.(2) when the incision of conjunctival approach 鈮，

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