保留上睑感觉神经分支的切开重睑术  

Full-incision double-eyelid blepharoplasty with selective sensory nerve preservation

作　　者：陈晓东 黄金龙 陈刚 王金明 Chen Xiaodong;Huang Jinlong;Chen Gang;Wang Jinming(Department of Plastic Surgery,Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院,江苏省中医院整形外科,南京210029

出　　处：《中华整形外科杂志》2023年第10期1082-1087,共6页Chinese Journal of Plastic Surgery

摘　　要：目的:介绍一种保留上睑感觉神经分支的切开重睑术。方法:回顾性分析2021年3月至2022年2月江苏省中医院整形外科采用保留上睑感觉神经分支的切开重睑术治疗的患者资料。术中沿设计线切开皮肤及眼轮匝肌,分离眼轮匝肌并暴露睑板前筋膜层,于瞳孔中线偏内侧可见1、2支斜向内走行的神经,仔细解剖并予以保留,于眶隔深面上行分离并去除部分眶隔脂肪,将切口下唇眼轮匝肌浅层和上睑提肌腱膜固定,形成自然的重睑弧度,无张力缝合皮肤。术后随访并发症发生情况;术后3~12个月以Semmens-Weinstein单丝采用轻触法检查重睑线上、下对应部位的触觉,评估重睑线下皮肤的触觉减退情况,分为无差别、轻度差别、明显差别3个等级;术后3~12个月由患者对手术效果满意度进行评价,分为非常满意、满意、一般、不满意4个等级。结果:共纳入79例双侧单睑患者(共158只眼),均为女性,年龄18~44岁,平均26.6岁。术后随访3~12个月,平均9.4个月。89.9%(142/158)上睑感觉评价为"无差别",10.1%(16/158)评价为"轻度差别"。无上睑麻木或感觉异常等不适症状发生。患者对手术效果满意率为94.9%(75/79)。2例患者术后外观轻度不对称;1例患者术后出现血肿,2周后自行吸收,重睑轻微不对称;1例患者切口瘢痕增生,予硅凝胶外涂结合脉冲染料激光干预后,于术后9个月恢复。结论:保留上睑感觉神经分支的切开重睑术是一种效果确切、重睑形态逼真、可保留重睑线下的皮肤感觉、损伤小、恢复快的新术式。ObjectiveTo introduce a new surgical method that retains the sensory nerve branches of the upper eyelid to achieve a more physiological double eyelid effect.MethodsData of patients in the Department of Plastic Surgery of Jiangsu Province Hospital of Chinese Medicine from March 2021 to February 2022,who underwent full-incision double-eyelid blepharoplasty with selective sensory nerve preservation were retrospectively analyzed.During the procedure,the skin and orbicularis oculi muscle were incised along the design line,the orbicularis oculi muscle was separated,and the pretarsal fascia layer was exposed.One or two oblique inward nerve branches could be seen on the medial side of the midline of the pupil,which were carefully dissected and preserved.The deep orbital septum was separated and part of the orbital septum fat was removed.Orbicularis oculi muscle-pretarsal fascia sutures were placed to form a natural double eyelid.Suture the skin without tension.Complications were followed up after operation.After 3 to 12 months of surgery,the tactile sensation of the corresponding areas above and below the double eyelid line was examined using the Semmens-Weinstein monofilament with light touch method.The tactile loss of the skin below the double eyelid line was evaluated and divided into three levels:no difference,mild difference,and significant difference.The patient’s satisfaction with the surgical outcome was evaluated and divided into four levels:very satisfied,satisfied,average,and dissatisfied.ResultsA total of 79 patients(158 eyes)with double eyelid blepharoplasty were enrolled in the study.The follow-up time was 3-12 months,with an average follow-up time of 9.4 months.The upper eyelid sensation of 89.9%(142/158)was evaluated as"no difference",and 10.1%(16/158)was evaluated as"mild difference".No patient reported discomfort symptoms such as upper eyelid numbness or sensory abnormalities.Two patients had slight asymmetry.One patient developed a hematoma,which was self-absorbed two weeks later with mild asymmetry

关 键 词：眼睑成形术 感觉减退 上睑感觉神经 麻木 

分 类 号：R779.6[医药卫生—眼科]