最大量提上睑肌切除术矫正重度先天性上睑下垂  

Maximal levator resection in treatment of severe congenital ptosis

作　　者：刘明锁 宁勇 李斌 郭丽 李俊逸 LIU Ming-suo;NING Yong;LI Bin;GUO Li;LI Jun-yi(Department of Burn Plastic Surgery,Shandong Provincial Corps Hospital of Chinese People’s Armed Police Forces,Shandong Province,250014,China;Department of Ophthalmology,Shandong Provincial Corps Hospital of Chinese People’s Armed Police Forces,Shandong Province,250014,China)

机构地区：[1]武警山东省总队医院烧伤整形科,山东济南250014 [2]武警山东省总队医院眼科,山东济南250014

出　　处：《中国医疗美容》2020年第5期1-5,共5页China Medical Cosmetology

摘　　要：目的评价最大量切除提上睑肌术矫治提上睑肌功能(Levator function,LF)低下的重度先天性上睑下垂的手术和美容效果。方法回顾性分析一系列连续病例。共122例122眼(105单侧和17双侧不对称性上睑下垂),进行最大量提上睑肌切除术。手术结果按优、良、差分级,并观察术后并发症。结果年龄3~56岁,平均随访时间21.9±9.9个月(3~36个月)。患者疗效优良率为93.0%。根据提上睑肌功能分为0~2 mm(40例)和2.5~4.0 mm(82例)两组。术前LF、睑缘角膜映光点距离(MRD)-1、提肌裂孔等因素与术后结果无关。并发症包括暴露性角膜病变(10.7%)、重睑皱褶不对称(8.2%)、睑内翻(8.2%)、过矫(3.3%)、睫毛下垂(3.3%)和结膜脱垂(0.8%)。结论最大量提睑肌切除术是治疗先天性上睑下垂的一种有效方法,即使在LF较差的患者中,也能获得更好的美容而自然的睑轮廓,并避免额部瘢痕。Objective To evaluate the postoperative surgical and cosmetic outcomes after maximal levator resection for severe congenital ptosis with poor levator function.Methods A retrospective case series was performed.A total of 122 patients with 122 eyelids(105 unilateral and 17 bilateral asymmetric ptosis)who underwent unilateral maximal levator resection were included.The surgical results were graded as excellent,good and poor and postoperative complications were documented.Results The mean age at the time of surgery was 8.8±9.2 years(range,3-56 years)with mean follow-up time of 21.9±9.9 months(range,3-36 months).The excellent and good rate was 93.0%in the patients.Patients were divided into two groups based on levator function as follows:0-2 mm(40 cases)and 2.5-4.0 mm(82cases).Factors such as preoperative levator function,margin re flex distance-1 and levator dehiscence were not correlated with postoperative surgical outcomes.Complications included exposure keratopathy(10.7%),lid crease asymmetry(8.2%),entropion(8.2%),overcorrection(3.3%),eyelash ptosis(3.3%)and conjunctival prolapse(0.8%).Conclusions Maximal levator resection is an effective procedure for congenital ptosis even in patients with poor levator function,which provides improved cosmesis,a more natural lid contour,and avoids brow scars.

关 键 词：上睑提肌 上睑下垂 疗效 并发症 

分 类 号：R779.6[医药卫生—眼科]