定制导引针在经结膜入路眶隔脂肪瓣释放矫正泪沟畸形中的应用  

Application of Custom Made Guide Needle in Correction of Tear trough Deformity by Releasing Orbital Septal Fat Flap in Transconjunctival Lower Blepharoplasty

作　　者：刘志坤 方卫婷 郑舒丹 谢红炬 LIU Zhikun;FANG Weiting;ZHENG Shudan;XIE Hongju(Department of Plastic Surgery,the Second Afiliated Hospital of Hainan Medical University,Haikou 570311,Hainan,China)

机构地区：[1]海南医科大学第二附属医院整形外科,海南海口570311

出　　处：《中国美容医学》2025年第1期25-28,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨在结膜入路眶隔脂肪瓣释放手术中,使用一种特制导引针辅助固定眶隔脂肪于上颌前间隙,以填充矫正泪沟畸形的临床效果。方法:回顾性分析2021年9月-2023年3月海南医科大学第二附属医院整形美容外科门诊就诊并手术的50例下睑袋伴有泪沟畸形的年轻就医者病例资料。术前坐位标记下睑袋突出部位及内侧眶下三角形凹陷区域,经结膜入路切口长约10 mm,在眶隔膜前方剥离至眶骨边缘后打开泪槽韧带直至上颌前间隙,彻底松解内侧、中央眶隔脂肪团,用6-0尼龙线缝合眶隔脂肪瓣尖端,用定制埋没导引针将其牵引至上颌前间隙下端表面皮肤穿出后打结埋置于皮下,结膜切口无需缝合。术后嘱予氯霉素滴眼液应用5 d。结果:术后随访6个月~2年,就医者结膜切口愈合良好,下睑袋消失,泪沟及眶下凹陷畸形得到明显改善。术后就医者均未出现感染、复视、血肿等并发症,3例就医者出现早期线结打结处凹陷,经按摩2~4周后逐渐消失。结论:对于下睑袋伴有泪沟畸形的年轻就医者,应用定制导引针经结膜入路将眶隔脂肪瓣释放填充于上颌前间隙,效果满意,值得临床推广。Objective To investigate the clinical effect of using a special guide needle to fix the orbital fat in the anterior maxillary space in order to fll and correct the lacrimal groove deformity during the operation of releasing the orbital fat flap through conjunctival approach.Methods From September 2021 to March 2023,a retrospective analysis was performed on 50 young patients with lower palpebral bags with tear trough deformity in the plastic surgery department of the second afiliated hospital of Hainan Medical University,including 8 males and 42 females,aged 18 to 30 years old,with an average age of 23 years old.The protrusion of the lower eyelid bag and the medial suborbital triangle depression were marked by sitting position before surgery.The incision length was about 10 mm via conjunctival approach.Before the anterior orbital diaphragm was stripped to the orbital bone edge,the tear trough ligament was opened to the anterior maxillary space,and the medial and central orbital septum fat pad was completely released.It was pulled to the surface of the lower of anterior maxillary space with a custom made guide needle,and then tied and buried under the skin.The conjunctival incision did not need to be sutured.Chloramphenicol eye drops were prescribed for 5 days after surgery.Results After 6 months to 2 years of follow-up,the conjunctival incision healed well,the lower eyelid bag disappeared,and the tear trough deformity and suborbital depression were significantly corrected.Postoperative complications such as infection,diplopia and hematoma were not found in all patients.3 patients had early depression at the knot,which gradually disappeared after 2 to 4 weeks of massage.Conclusion For the young patients with lower eyelid bags and tear trough deformity,the use of custom made guiding needle to release and fll the orbital septum fat flap into the anterior maxillary space via conjunctival approach has satisfactory effect and is worthy of clinical promotion.

关 键 词：下睑袋 泪沟畸形 结膜入路 上颌前间隙 导引针 

分 类 号：R779.6[医药卫生—眼科]