经结膜入路下睑成形术联合精微自体脂肪移植在眶下区年轻化中的应用  

Application of lower eyelid blepharoplasty by transconjunctival approach combined with micro-autologous fat transplantation in the rejuvenation of the infraorbital region

作　　者：张天琦 陈威 周莉娜 陈浩 付秋悦 张杉 黄金龙 陈刚 Zhang Tianqi;Chen Wei;Zhou Lina;Chen Hao;Fu Qiuyue;Zhang Shan;Huang Jinlong;Chen Gang(Department of Plastic Surgery,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整形外科,南京210029 [2]南京医科大学第二附属医院整形外科,南京210003 [3]张家港市中医院甲乳外科,张家港215699

出　　处：《中华整形外科杂志》2024年第10期1101-1108,共8页Chinese Journal of Plastic Surgery

摘　　要：目的观察下睑成形术联合精微自体脂肪移植(MAFT)应用于眶下区年轻化的治疗效果。方法回顾性分析2020年3月至2022年3月南京中医药大学附属医院整形外科采用下睑成形术联合MAFT治疗的下睑袋伴泪沟凹陷患者的临床资料。患者因下睑袋合并泪沟就诊,伴或不伴有皮肤松弛,部分患者伴有不同程度的中面部低平、凹陷。术前对患者的眶下区、中面部凹陷进行检查和评估,制定适宜的个体化方案。术中行经结膜入路下睑成形术联合泪沟MAFT,对于中面部低平或凹陷的患者同时行中面部MAFT,对于皮肤松弛者同时行皮肤去除术。记录术后并发症情况。术前、术后6个月以上随访时拍摄患者面部各角度照片,由同一位医生进行患者泪沟Barton分级(0~3级,分级越高表示泪沟越明显),比较手术前后泪槽畸形的改善情况,并进行整体美学改善量表(GAIS)评分,由患者进行求美者自身美学提升量表(PAIS)评分(GAIS和PAIS均为1~5分,分值越高表示术后改善越显著)。正态分布计量资料以±s表示,计数资料以频数和(或)百分数表示;偏态分布计量资料以M(Q_(1),Q_(3))表示,采用秩和检验进行比较。结果共纳入69例下睑袋伴泪沟凹陷患者,男9例,女60例,年龄25~45岁,平均36.7岁。其中35例伴有中面部凹陷,11例伴有下睑皮肤松弛。术中每侧眼轮匝肌下注射(0.37±0.07)ml(0.2~0.6 ml)精微自体脂肪,每侧皮下层注入(0.18±0.06)ml(0.1~0.2 ml)精微自体脂肪,每侧中面部颊内侧深脂肪室、梨状孔脂肪室注射(3.80±0.98)ml(3~5 ml)精微自体脂肪。术后均未出现严重并发症。随访6~13个月,平均8.7个月,患者下睑袋、泪沟及中面部凹陷均得到改善,呈现眶下区-中面部饱满流畅的年轻外观,下睑区皮肤质地改善。末次随访时,泪沟Barton分级较术前下降,差异有统计学意义[0(0,1)级vs.2(1,2)级,Z=-7.62,P<0.001]。末次随访时,69例患者的PAIS评分:49例(71%)为5ObjectiveTo observe the clinical effect of lower eyelid blepharoplasty combined with micro-autologous fat transplantation(MAFT)in the rejuvenation of the infraorbital regions.MethodA retrospective analysis was conducted on the clinical data of patients with lower eyelid pouch and tear trough treated with lower eyelid blepharoplasty combined with MAFT in the Department of Plastic Surgery of Affiliated Hospital of Nanjing University of Chinese Medicine from March 2020 to March 2022.Patients seeked medical attention due to lower eyelid pouch and tear trough,with or without skin laxity,and some patients had varying degrees of midface depression.After preoperative examination and evaluation of the patient’s infraorbital area and midfacial depression,appropriate individualized plans were developed.The patient underwent lower eyelid blepharoplasty by transconjunctival approach combined with tear trough MAFT.For patients with low or depressed midface,midface MAFT was also performed,and for patients with skin laxity,skin removal surgery was performed simultaneously.Complications were recorded after the operation.Preoperative and postoperative photos of more than 6 months were taken with the same postion and delivered to the same doctor to grade the patient’s Barton classification(0-3 grades,with higher grade indicating more obvious tear trough deformity).The improvement of tear trough deformity after surgery was assessed,and the global aesthetic improvement scale(GAIS)score was also assessed.The patients evaluated their improvement using the patients aesthetic improvement scale(PAIS)score(GAIS and PAIS are both 1-5 points,with higher scores indicating more significant postoperative improvement).Normal distribution metric data was represented by Mean±SD,and count data was represented by frequency and/or percentage;skewed distribution metric data was represented by M(Q_(1),Q_(3)),and compared by rank sum test.ResultsA total of 69 patients were enrolled,including 9 males and 60 females,aged 25-45 years,with an average a

关 键 词：眼睑成形术 泪槽畸形 精微自体脂肪移植 年轻化 

分 类 号：R622.9[医药卫生—整形外科]