显微手术治疗重度先天性上睑下垂疗效评估  

The effect of microsurgery for severe congenital ptosis

作　　者：李建强 黄扬 张秋玲 

机构地区：[1]通化解放军206医院眼科,吉林134000

出　　处：《中国实用眼科杂志》2013年第10期1342-1345,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨利用显微手术治疗重度先天性上睑下垂的临床疗效。方法前瞻性随机对照研究。符合重度先天性上睑下垂的患者42例60只眼纳入研究。采用随机数字表法将患者分为显微镜组及肉眼组，两组分别为22例32只眼和20例28只眼。所有患者术前均行视力、眼压、裂隙灯显微镜、直接检眼镜、散瞳眼底彩色照相、眼B型超声、泪膜破裂时间（BUT）、基础泪液分泌试验（SIT）及上睑下垂程度的测定。观察术后两组手术时问、疗效、并发症及干眼症状发生情况。结果两组平均手术时间比较，差异无统计学意义（P〈0．05）。术后1周疗效评估：术后不满意上睑位置、上睑弧度、上睑活动度及仰头视物者，两组间差异无统计学意义（P〉0．05）。术后并发症，如斜视与复视、穹窿结膜脱垂及暴露性角膜炎．两组问差异无统计学意义（P〉0．05），但上睑内翻、倒睫，两组间差异有统计学意义（P〈0．05）。术后两组患眼不同时间BUT及SIT长度的比较：手术后1、3、6个月，肉眼手术组BUT、SIT长度与术前比较，差异有统计学意义（P〈0．05）。手术后1、3个月，显微镜手术组BUT、SIT长度与术前比较，差异有统计学意义（P〈0．05）；手术后6个月BUT、SIT长度与术前比较，差异无统计学意义（P〉0．05）。结论显微手术治疗重度上睑下垂，可使手术操作更加精细，减少了并发症及干眼症状的发生率。Objective To assess the effect of microsurgery for severe congenital ptosis. Meth- ods This was a prospective randomized study. Forty two patients （60 eyes） suffering from severe congenital ptosis were randomly divided into naked-eye group （20 patients, 28 eyes） and microscope group （22 patients, 32 eyes）. Visual acuity, intraocular pressures, direct ophthalmoscopy, slit lamp mi- croscope, B-scan ultrasound, tear film break up time （BUT） and Schirmer I test （SIT） were observed and measured. Operation time, postoperative complications and dry eye symptom were analyzed. Results At last follow-up, the mean surgical times were no statistical difference between two groups （P 〈0.05）. One week after operation, there were no statistical difference between two groups because of upper eyelid location, radian, movement and looking up （P 〉0.05）. There were no significant dif-ference between two groups because of diplopia, conjunctiva prolapse and exposure keratitis after op-eration （P 〉0.05）, but two groups were significantly different because of trichiasis （P 〈0.05）. In na-ked-eye group, there were significant difference in BUT and SIT compared with those preoperatively at the first, third, and sixth month after operation （P 〈0.05）. In microscope group, there were signifi-cant difference in BUT and SIT compared with those preoperatively at the first and third month af-ter operation （P 〈0.05）, but there were no statistical difference in BUT and SIT compared with those preoperatively at the sixth month （P 〉0.05）. Conclusions Microsurgery is an effective meth-od. The anatomical structure is clear, hurt is slight, and has less postoperative complications.

关 键 词：显微手术 提上睑肌缩短术 先天性上睑下垂 

分 类 号：R777.1[医药卫生—眼科]