滑行睑板结膜瓣联合异体巩膜移植一期重建眼睑后层缺损的临床效果  

Sliding tarso-conjunctival flap combined with allogeneic sclera transplantation for one-stage posterior eyelid defect

作　　者：李俊萍 黎冬平 周娜 罗彦竹 王育红 Li Junping;Li Dongping;Zhou Na;Luo Yanzhu;Wang Yuhong(Hankou Aier Eye Hospital,Wuhan 430021,China;Aier Eye Hospital(East of Chengdu),Chengdu 610051,China;Dongguan Aier Eye Hospital,Dongguan 523000,China;Aier School of Ophthalmology,Central South University,Changsha 410015,China)

机构地区：[1]汉口爱尔眼科医院,武汉430021 [2]成都东区爱尔眼科医院,610051 [3]东莞爱尔眼科医院,523000 [4]中南大学爱尔眼科学院,长沙410015

出　　处：《中华整形外科杂志》2021年第12期1364-1369,共6页Chinese Journal of Plastic Surgery

摘　　要：目的探讨滑行睑板结膜瓣联合异体巩膜移植一期重建眼睑后层缺损的效果。方法选择2015年1月至2019年3月汉口爱尔眼科医院收治的眼睑肿瘤患者,手术切除肿瘤,良性肿瘤于边缘外1~2 mm切除送病理检查,恶性肿瘤按Mohs法切除,术中送冰冻切片。肿瘤切除后垂直方向均残留睑板,上睑≥3 mm,下睑≥2 mm。后层缺损重建采用残留睑板结膜瓣滑行至睑缘,后方睑板缺损区采用异体巩膜修补;前层缺损采用滑行皮瓣、旋转皮瓣或游离皮片等重建。术后随访观察睑缘形态、眼睑缺损区修复情况、眼睑活动度及开闭、上提功能。结果共选择8例眼睑肿瘤患者,男3例,女5例,年龄31~76岁,平均42岁。眼睑皮内痣2例,眼睑基底细胞癌1例,睑板腺癌4例,眼睑鳞状细胞癌1例,病变均越过灰线累及睑板。术后随访6~24个月,8例均无肿瘤复发,除重建区域睑缘无睫毛外,眼睑形态良好。眼睑活动度佳、开闭及上提功能正常。患者无明显异物感,无异体巩膜溶解或排斥反应。结论患者眼睑肿瘤切除后,垂直方向残留上睑睑板≥3 mm、下睑睑板≥2 mm时,采用滑行睑板结膜瓣联合异体巩膜移植一期重建眼睑后层缺损,在外观和功能方面均能取得满意效果。Objective To explore the effect of sliding tarso-conjunctival flap combined with allogeneic scleral transplantation for one-stage reconstructing posterior eyelid defect.Methods The clinical data of eyelid tumor patients who admitted to Hankou Aier Eye Hospital from January 2015 to March 2019 were collected.The lesions crossed the gray line and the tarsal plates were involved.The benign tumor was removed from the margin by 1-2 mm and the pathological examination was performed.Mohs method(intraoperative delivery of frozen sections to control the cut edge)resection was performed for malignant tumor.The residual tarsal plate in the vertical direction after tumor was removed(upper eyelid≥3 mm,lower eyelid≥2 mm).The posterior defect reconstruction was performed by sliding the residual tarsal conjunctival flap to the eyelid margin,and the posterior tarsal defect was repaired with allogeneic sclera.The anterior defect was reconstructed with sliding flaps,rotating flaps and free skin grafts.The postoperative follow-up was performed to observe the morphology of the eyelid margin,the repair of the eyelid defect area,the degree of movement of the eyelid and the function of opening and closing,and lifting.Results A total of 8 cases were included,3 males and 5 females,aged 31-76 years,with an average of 42 years old.2 cases of eyelid intradermal nevi,1 case of eyelid basal cell carcinoma,4 cases of eyelid adenocarcinoma,and 1 case of eyelid squamous cell carcinoma.All patients were followed up for 6 to 24 months.All of the 8 patients had no tumor recurrence.Aside from the absence of eyelashes in the reconstructed area,the eyelids were in good shape.The movement of eyelid was good,the functions of opening and closing and lifting were normal.Patients did not complain about foreign body sensation.No allogeneic sclera dissolution or rejection.Conclusions For the residual tarsal plate in the vertical direction after tumor resection(upper eyelid≥3 mm,lower eyelid≥2 mm).The use of the sliding tarso-conjunctival flap combined

关 键 词：睑板结膜瓣 异体巩膜 眼睑缺损 肿瘤 眼睑 

分 类 号：R779.6[医药卫生—眼科]