经结膜入路修复腱膜性上睑下垂  

The clinical effect of transconjunctival approach in repair of aponeurotic ptosis

作　　者：施婧 赵英楠 陈文 Shi Jing;Zhao Yingnan;Chen Wen(Department of Facial and Neck Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,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面颈整形科,北京100144

出　　处：《中华整形外科杂志》2023年第10期1118-1123,共6页Chinese Journal of Plastic Surgery

摘　　要：目的:探讨经结膜入路矫治腱膜性上睑下垂的手术效果。方法:回顾性分析2020年9月至2022年3月中国医学科学院整形外科医院面颈整形科采用经结膜入路矫治腱膜性上睑下垂的患者资料。术中纵向切开上睑结膜并分离米勒肌后,寻找上睑提肌腱膜,并将其末端与眶隔后壁融合的白线结构固定于睑板上缘。手术效果评价:(1)矫正程度,包括正矫、矫正过度和矫正不足;(2)对称性,分为好、中、差3个等级;(3)稳定性,分为好、减弱、消失3个等级;(4)术后并发症;(5)患者满意度,分为满意、一般、不满意3个等级。结果:共纳入23例患者(37只眼),男9例,女14例,年龄22~41岁,平均31岁;轻度下垂21只眼,中度下垂9只眼,重度下垂7只眼。随访6~18个月,平均13.5个月。全部37只眼(100%)术后矫正程度、稳定性评价为正矫、稳定性良好;对称性评价"好"21例(91.3%),"中"2例(8.7%)。所有患者对矫正效果满意,眼部外观及功能恢复正常,未出现严重的术后并发症。结论:通过结膜入路进行腱膜性上睑下垂矫正,能够在获得良好效果的同时,减小手术损伤,术后眼睑肿胀轻微、恢复快,眼睑外观自然无痕。ObjectiveTo investigate the surgical technique and therapeutic effect for the repair of aponeurotic ptosis via a transconjunctival approach.MethodsA retrospective analysis was conducted on patient data from the Department of Facial and Neck Plastic Surgery,the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College from September 2020 to March 2022.These patients were treated for aponeurotic ptosis through a transconjunctival approach.During the operation,after the upper eyelid conjunctiva was incised longitudinally and the Müller muscle was separated,the end of the levator aponeurosis and the white line were fixed on the upper edge of the tarsus.Evaluation of surgical effect:(1)degree of correction,including normal correction,over correction and under correction;(2)symmetry,divided into good,medium,poor 3 grades;(3)stability,divided into good,weakened,disappeared 3 grades;(4)postoperative complications;(5)patient satisfaction was divided into three levels:satisfactory,general and unsatisfactory.Results23 cases(37 eyes)were treated,including 9 males and 14 females,aged 22-41 years(mean 31 years),including mild ptosis in 21 eyes,moderate ptosis in 9 eyes,and severe ptosis in 7 eyes.Follow up period was 6-18 months,with an average of 13.5 months.All 37 eyes(100%)were evaluated as normal corrective and good stability after surgery.Symmetry evaluation showed"good"in 21 cases(91.3%)and"moderate"in 2 cases(8.7%).All patients were satisfied with the correction effect of ptosis with normal eyelid appearance and function.No severe postoperative complications happened.ConclusionThe transconjunctival approach can correct aponeurotic ptosis with good result and low morbidity.Quick postoperative recovery and natural eyelid appearance can be achieved.

关 键 词：眼睑下垂 腱膜性上睑下垂 结膜入路 上睑提肌 

分 类 号：R779.6[医药卫生—眼科]