结膜入路Müller氏肌切除联合提上睑肌断腱治疗上睑退缩疗效观察  

Clinical observation of conjunctival approach Müller's resection combined with levator tendon excision in the treatment of upper eyelid retraction

作　　者：马琛 曹家敏 陈灼琨 陈海燕 熊炜[2] 张凤 MA Chen;CAO Jiamin;CHEN Zhuokun;CHEN Haiyan;XIONG Wei;ZHANG Feng(Depurtment of Ophthalmology,The Affiliated Children's Hospial of XiangYa School of Medicine,Central South Universily,Changshu 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院眼科,湖南长沙410007 [2]中南大学湘雅三医院眼科,湖南长沙410000

出　　处：《中国美容整形外科杂志》2024年第5期257-262,共6页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 探讨结膜入路Müller氏肌切除联合提上睑肌断腱术对矫正静止期甲状腺相关眼病中重度上睑退缩的临床疗效。方法 采用病例系列研究方法,收集自2020年5月至2022年8月,于中南大学湘雅三医院眼科确诊甲状腺相关眼病中重度上睑退缩的20例(24只眼)患者,对所有患者实施结膜入路Müller氏肌切除联合提上睑肌断腱术,术后随访6个月,评价其临床疗效。结果 术后6个月,24只患眼中完全矫正18只眼(75.00%),明显改善4只眼(16.67%),无效2只眼(8.33%),总有效率为91.67%(22/24);24只患眼中术后复发2只眼(8.33%),出现并发症2只眼(8.33%),其中1只眼上睑下垂,1只眼睑外翻,后期分别行上睑提肌缩短术及睑外翻矫正术后完全矫正;术后3个月,上睑退缩矫正量平均为2.79 mm,术后6个月,矫正量平均为2.29 mm,差异具有统计学意义(P<0.001);术后6个月,甲状腺相关眼病患者生活质量调查问卷社会心理、视功能评分及术后鼻侧角膜缘、瞳孔中点、颞侧角膜缘3个垂直方向重睑宽度均高于术前,差异有统计学意义(P<0.05);临床活动度评分、上睑退缩度、眼球突出度数值越大的患者其术后复发率越高、有效率越低,且以上3种指标均与客观外貌评价有效率呈负性线性关系(P<0.05)。结论 经结膜入路Müller氏肌切除联合提上睑肌断腱术对矫正静止期甲状腺相关眼病中重度上睑退缩的临床疗效确切,能有效矫正上睑退缩、增加重睑宽度、改善外貌进而提高患者生活质量。Objective To investigate the clinical efficacy of conjunctival approach Müller's resection in combination with levator tendon excision in the treatment of moderate to severe upper eyelid retraction in quiescent thyroid-related ophthalmopathy. Methods A case series approach was used in this study. A total of 20 patients(24 eyes) with moderate to severe upper eyelid retraction in thyroid-related ophthalmopathy were selected from May 2020 to August 2022, and Müller's excision combined with levator tendon dissection through conjunctival approach was performed on all patients, who were followed up for 6 months after surgery to evaluate its clinical efficacy.Results At 6 months after surgery, 18 of the 24 eyes were completely corrected(75. 00%), 4 eyes were significantly improved(16.67%),and 2 eyes were ineffective(8.33%), with an overall efficacy rate of 91.67%(22/24);2 of the 24 eyes had postoperative recurrences(8.33%), and 2 of the 24 eyes(8.33%) developed complications, 1 eye had ptosis and 1 eye had upper eyelid ectropion, which was fully corrected after upper eyelid levator shortening and ectropion correction, respectively, performed at a later stage;the mean amount of upper eyelid retraction to be corrected was 2.79 mm at 3 months and 2.29 mm at 6 months postoperatively, and the difference was statistically significant(P<0.001). The psychosocial and visual function scores of the Quality of Life Questionnaire for Patients with Thyroid Associated Ophthalmopathy as well as the postoperative crease width in the vertical axis through the pupil centre, lateral limbus and medial limbus of the cornea at 6 months postoperatively were significantly higher than those before surgery(P<0.05). Patients with higher values of clinical activity score, upper eyelid retraction and ocular proptosis had a higher postoperative recurrence rate and a lower efficiency rate, and all three of the above indexes showed a negative linear relationship with the efficiency rate of objective appearance evaluation(P<0.05).Conclusion Conjunctiv

关 键 词：上睑退缩 Müller氏肌切除术 提上睑肌断腱术 

分 类 号：R779.6[医药卫生—眼科]