弧形额肌筋膜瓣治疗中重度先天性上睑下垂疗效观察  

CLINICAL OBSERVATION OF MODERATE TO SEVERE BLEPHAROPTOSIS CORRECTION WITH ARC-SHAPED FRONTALIS APONEUROSIS FLAP

作　　者：李正勇[1] 伍俊良[1] 岑瑛[1] 张振宇[1] 陈志兴[1] 陈俊杰[1] 

机构地区：[1]四川大学华西医院烧伤整形科,成都610041

出　　处：《中国修复重建外科杂志》2016年第4期457-460,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用弧形额肌筋膜瓣治疗中、重度先天性上睑下垂的疗效。方法 2011年1月-2014年12月,收治80例（140侧）中、重度先天性上睑下垂患者。男31例,女49例;年龄6-45岁,中位年龄16岁。单侧20例,双侧60例。患者平视前方时,上睑下垂3-6 mm,平均5 mm。51例曾接受矫形术,其余患者均为初次手术。术中通过眉部中份切口制备额肌筋膜瓣,沿眼轮匝肌下隧道将其下降至睑板上缘缝合固定悬吊上睑至过矫位。结果患者手术均顺利完成。术中出血量为5-10 m L,平均7 m L。术后切口轻度肿胀,3-5 d后消肿;切口均Ⅰ期愈合,无感染、皮瓣坏死等并发症发生。患者均获随访,随访时间1-3年,平均1.5年。79例患者于术后3个月内能完全闭合上睑,上睑功能均重建良好;1例单侧患者术后6个月尚不能完全闭合上睑,伴发轻度角膜炎,经睑缘粘连术治疗后完全闭合。结论采用弧形额肌筋膜瓣治疗中、重度先天性上睑下垂可获较好疗效,具有创伤小、安全可靠、手术操作简便等优点。Objective To evaluate the effectiveness of an arc-shaped frontalis aponeurosis flap for the treatment of moderate to severe blepharoptosis. Methods Between January 2011 and December 2014, 80 cases（140 eyes） of moderate to severe blepharoptosis were treated, including 31 males and 49 females with a median age of 16 years（range, 6-45 years）. One eye was involved in 20 cases and both eyes in 60 cases. Upper eyelid ptosis degree ranged from 3 to 6 mm（average, 5 mm） when looking at the front horizontally. Fifty-one patients had underwent plastic surgery, and the first operation was performed in others. The arc-shaped frontalis aponeurosis flap was created by incision of upper and middle edge of the eyebrow, then it was retracted to the upper eyelid aponeurosis and was fixed in a slight over-correction position. Results The operation was completed smoothly. The intraoperative blood loss was 5-10 m L（mean, 7 m L）. Mild swelling of incision was observed after operation, and disappeared at 3-5 days after operation. Primary healing of incision was obtained, with no complications of infection and flap necrosis. The follow-up duration was 1-3 years（mean, 1.5 years）. Seventy-nine cases could close upper eyelid completely and the function of upper eyelid was satisfactory within 3 months. One patient could not close upper eyelid completely after 6 months, and mild keratitis occurred, which was cured by anchyloblepharon. Conclusion The arc-shaped frontalis aponeurosis flap can be regarded as a minimally invasive procedure for the treatment of congenital moderate to severe blepharoptosis, it was safe, reliable, and easy-to-grasp.

关 键 词：上睑下垂 弧形额肌筋膜瓣 悬吊术 

分 类 号：R779.6[医药卫生—眼科]