上睑臃肿的软组织构成及个性化处理  

Soft tissue composition and tailor-made blepharoplasty for upper eyelid puffiness

作　　者：都乐 靳小雷 宗宪磊 宋国栋 杨常盛 Du Le;Jin Xiaolei;Zong Xianlei;Song Guodong;Yang Changsheng(The 16th Department of Plastic and Reconstructive Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院整形十六科,北京100144

出　　处：《中华医学美学美容杂志》2021年第3期195-198,共4页Chinese Journal of Medical Aesthetics and Cosmetology

摘　　要：目的探讨上睑臃肿的软组织构成及其在上睑成形术中的处理经验。方法2017年1月至2018年12月,就诊于中国医学科学院整形外科医院整形十六科的单睑伴上睑臃肿女性患者165例,年龄18~40(26.1±6.2)岁。行切开法重睑手术过程中,去除多余皮肤及眼轮匝肌,常规暴露眶隔前壁,观察眼轮匝肌后脂肪及眶隔脂肪容量,对眶隔前壁膨出者全层打开眶隔并探查泪腺。根据软组织的构成情况行眼轮匝肌后脂肪及眶隔脂肪部分去除或调整,泪腺复位联合脂肪瓣转移等手术方法进行综合处理。结果165例患者切口均为一期愈合,随访6~24个月,手术效果稳定,偶见持续轻度疼痛、局部皮肤紧绷感、溢泪、球结膜水肿等均在短期内自行缓解。无严重不良反应及并发症。结论上睑成形术中识别上睑臃肿的软组织构成并有针对性地进行处理,可更好地平衡上睑脂肪组织容量,避免术后复发或黏连形成凹陷,使重睑形态更加自然柔和。Objective To explore the soft tissue composition underlying upper eyelid puffiness and the experience in treating it with tailor-made procedure during upper blepharoplasty.Methods In a retrospective study from January 2017 to December 2018,165 patients with upper eyelid puffiness underwent full-incision upper blepharoplasty.During the procedure,the anterior wall of orbital septum was exposed,and the volume of the retro-orbicularis oculus fat(ROOF)and preaponeurotic fat was observed.The orbital septum would be opened if lacrimal gland prolapse was suspected.The puffy upper eyelid would be targeted with tailor-made procedure such as partial ROOF resection,removal or transposition of the preaponeurotic fat,as well as lacrimal gland refixation.Results All 165 cases were healed by first intention.No relapse was found after a 6 to 24 months follow-up.Persistent mild pain and local skin tightness epiphora chemosis were presented in isolated cases with self-resolution within a short time.There were no severe adverse reaction or complications occurred during the operation and follow-up.Conclusions The tailor-made procedure during upper blepharoplasty targets the soft tissue anatomy underlying upper eyelid puffiness.It is safe and effective in maintaining a natural look of upper eyelids while retaining the appropriate amount of adipose tissue in the upper eyelid.

关 键 词：眼睑成形术 上睑臃肿 眼轮匝肌后脂肪 泪腺脱垂 

分 类 号：R779.6[医药卫生—眼科]