多元组织移植在眼睑分裂痣整形外科修复中的应用  

The application of multi-tissue transplantation in the surgical repair of eyelid divided nevus in plastic surgery

作　　者：罗思思 卢晓昭 杨喆 马宁 陈森 李养群 Luo Sisi;Lu Xiaozhao;Yang Zhe;Ma Ning;Chen Sen;Li Yangqun(Hypospadias Plastic Surgery Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China;Department of Plastic Surgery,Tianjin Hedong District Traditional Chinese Medicine Hospital,Tianjin 300000,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尿道下裂整形中心,北京100144 [2]天津市河东区中医院整形外科,天津300000

出　　处：《中华整形外科杂志》2024年第3期300-306,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探讨多元组织移植在眼睑分裂痣手术治疗的临床效果及策略。方法回顾性分析2005年1月至2022年1月,于中国医学科学院整形外科医院尿道下裂整形中心就诊的眼睑分裂痣患者临床资料。手术分为4种。(1)直接切除缝合术;(2)单纯游离植皮术:根据缺损大小,上睑及下睑创面以中厚或全厚皮片覆盖;(3)眼轮匝肌肌皮瓣联合游离植皮术:上睑缺损及下睑近缘处缺损以皮片移植,下睑缺损以同侧眼轮匝肌蒂颞区皮瓣修复;(4)眼轮匝肌为蒂的颞区扩张皮瓣联合游离植皮术:手术分两期,一期手术于患侧颞区置入扩张器,二期手术取出扩张器后,行眼睑病变组织切除,再形成外眦眼轮匝肌眶部为蒂的岛状皮瓣,旋转180°后覆盖下睑缺损,上睑及下睑近睑缘处缺损仍以皮片移植。通过门诊、电话及微信随访患者术后面部外观及眼部运动等情况。采用SPSS 22.0统计软件进行分析,计量资料以±s表示,组内术前及术后颜面部修复重建术后疗效评估标准建议(A&F)评分比较采用配对t检验,P<0.05为差异有统计学意义。结果共纳入34例患者,男18例,女16例,年龄(17.7±15.3)岁(2~33岁)。眼睑分裂痣面积为0.3 cm×0.2 cm~14.0 cm×14.0 cm。直接切除缝合术6例,其中同时行重睑术2例,术后A&F评分(4.54±1.32)分较术前(3.28±0.98)分提高,差异无统计学意义(P>0.05);单纯游离植皮术10例,术后A&F评分(5.13±1.59)分较术前(2.25±1.59)分高,差异无统计学意义(P>0.05);眼轮匝肌肌皮瓣联合游离植皮7例,术后A&F评分(5.54±1.46)分较术前(2.18±1.61)分明显提高,差异有统计学意义(P<0.05);眼轮匝肌为蒂的颞区扩张皮瓣联合游离植皮术11例,术后A&F评分(4.95±0.60)分较术前(2.18±1.48)分提高,差异无统计学意义(P>0.05)。所有患者切口均一期愈合,皮片或皮瓣成活良好,眼睑功能正常。28例患者获得8~81个月随访,其中3例术后继发下睑外翻畸形,3例切口及植皮区Objective To investigate the clinical efficacy of different surgical approaches for repairing eyelid coloboma.Methods Patients with the divided nevus of eyelid treated at Hypospadias Plastic Surgery Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,from January 2005 to January 2022 were included.The surgeries were categorized into 4 types.(1)Direct excision and suture.(2)Local skin grafts:covering the defect with split-or full-thickness skin grafts according to the size of the defect on the upper and lower eyelids.(3)Combined skin grafts with orbicularis oculi myocutaneous flap:grafting skin flaps for defects on the upper eyelid and near the lower eyelid,and temporal area skin flaps based on the same side orbicularis oculi muscle pedicle for lower eyelid defects.(4)Temporal area expanded flap based on the orbicularis oculi muscle combined with skin grafts:the surgery was divided into two stages,the first stage involves the placement of an expander in the temporal area of the affected side,and the second stage involves the removal of the expander,excision of eyelid lesion tissue and formation of an island-shaped skin flap with the orbital part of the orbicularis oculi muscle pedicle as the pedicle,which was rotated 180°to cover the lower eyelid defect.Defects near the upper and lower eyelid margins were still covered with skin grafts.Follow-up was conducted through outpatient visits,telephone calls,and WeChat messaging to assess facial appearance postoperatively.SPSS 22.0 statistical software was used for analysis,and the measurement data were expressed as Mean±SD,the count data were expressed as percentage,and the comparison of preoperative and postoperative was calculated by aesthetic and functional status of facial soft-tissue deformities(A&F scores)within the group was performed by paired t-test,the difference was considered statistically significant at P<0.05.Results A total of 34 patients were included;average age was 17.7±15.3 years.The size of the lesio

关 键 词：眼睑 先天性分裂痣 组织移植 皮瓣 外科治疗 

分 类 号：R779.6[医药卫生—眼科]