经结膜入路眶隔脂肪“超释放”矫正泪沟及睑颊沟凹陷的下睑袋成形术  

Transconjunctival lower eyelid blepharoplasty with“super released”orbital fat in correction of tear trough and palpebromalar groove depression

作　　者：黄尚扬 肖海涛[1] 胡华[1] 岑瑛[1] HUANG Shangyang;XIAO Haitao;HU Hua;CEN Ying(Department of Plastic and Burn Surgery,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西医院美容整形/烧伤外科,成都610041

出　　处：《中国修复重建外科杂志》2023年第6期713-716,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨经结膜入路眶隔脂肪“超释放”后行眶隔脂肪带蒂前移矫正泪沟、睑颊沟凹陷的下睑袋成形术疗效。方法回顾分析2021年9月—2022年5月符合选择标准的82例(164侧)下睑袋膨出合并泪沟、睑颊沟凹陷患者临床资料。男3例,女79例;年龄22~46岁,平均34.5岁。患者均存在不同程度睑袋膨出及泪沟、睑颊沟凹陷;根据Barton分级标准对泪沟进行分级:Ⅰ级64侧,Ⅱ级72侧,Ⅲ级28侧。术中经下睑结膜入路,彻底松解包裹眶隔脂肪的膜性结构使眶隔脂肪充分疝出,直至疝出的脂肪条于静置松弛状态下无明显自行回缩,以此作为“超释放”标准。将释放的脂肪条平铺至颧前间隙和上颌前间隙中,并经皮固定至中面部,穿出皮肤的缝线不打结,以胶布黏贴方式外固定。结果术后出现轻度球结膜水肿表现3侧,中面部皮肤麻木1侧,轻度下睑退缩1侧,轻微内侧眼袋残留5侧。术后无血肿、感染、复视等并发症发生。患者均获随访,随访时间4~8个月,平均6.2个月。患者睑袋膨出及泪沟、睑颊沟凹陷均显著改善。末次随访时,根据Barton分级标准达0级158侧、Ⅰ级6侧,与术前比较差异有统计学意义(P<0.001);患者自评满意度达非常满意67例(81.7%),满意10例(12.2%),一般满意4例(4.8%),不满意1例(1.2%)。结论采用眶隔脂肪“超释放”矫正泪沟、睑颊沟凹陷可以有效避免眶隔脂肪回缩,降低术后睑袋残留或复发概率,提升矫正效果。Objective To investigate effectiveness of transconjunctival lower eyelid blepharoplasty with“super released”orbital fat in correction of lower eyelid pouch protrusion and tear trough and palpebromalar groove depression.Methods A clinical data of 82 patients(164 sides)with lower eyelid pouch protrusion and tear trough and palpebromalar groove depression,who met the selection criteria between September 2021 and May 2022,was retrospectively analyzed.Of the included patients,3 were males and 79 were females,with an average age of 34.5 years(range,22-46 years).All patients had varying degrees of eyelid pouch protrusion and tear trough and palpebromalar groove depression.The deformities were graded by the Barton grading system as gradeⅠin 64 sides,gradeⅡin 72 sides,and gradeⅢin 28 sides.The orbital fat transpositions were performed through the lower eyelid conjunctival approach.The membrane surrounding the orbital fat was completely released,allowing the orbital fat to fully herniate until the herniated orbital fat did not retract significantly in a resting and relaxed state,which is regarded as the“super released”standard.The released fat strip was spread into the anterior zygomatic space and the anterior maxillary space,and percutaneous fixed to the middle face.The suture that penetrates the skin was externally fixed by adhesive tape pasting without knotted.Results There were 3 sides with chemosis after operation,1 side with facial skin numbness,1 side with mild lower eyelid retraction at the early stage after operation,and 5 sides with slight pouch residue.No hematoma,infection,or diplopia occurred.All patients were followed up 4-8 months,with an average of 6.2 months.The eyelid pouch protrusion,tear trough,and palpebromalar groove depression were significantly corrected.At last follow-up,the deformity was graded by Barton grading system as grade 0 in 158 sides and gradeⅠin 6 sides,with a significant difference compared to the preoperative score(P<0.001).Patient's self-evaluation satisfaction reached

关 键 词：下睑袋成形术 眶隔脂肪 超释放 睑袋 泪沟 

分 类 号：R779.6[医药卫生—眼科]