上睑提肌腱膜纤维瓣法重睑成形术的应用效果  

Application effect of double eyelid plasty with the levator palpebrae superioris aponeurosis fiber flap method

作　　者：李国豪 廖怀伟[1] 施彦 齐钰涵 文辉才[1] Li Guohao;Liao Huaiwei;Shi Yan;Qi Yuhan;Wen Huicai(Plastic Surgery Department,the First Affiliated Hospital of Nanchang University,Nanchang 330000,China)

机构地区：[1]南昌大学第一附属医院整形外科,南昌330000

出　　处：《中华整形外科杂志》2025年第1期1-7,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探讨上睑提肌腱膜纤维瓣法重睑成形术的临床应用效果。方法2021年3月,在5具5侧汉族成年尸头单睑标本(南昌职业卫生学院解剖室提供)的上睑中间处,垂直(矢状面)切取宽3 mm的组织条带,行Masson染色,观察上睑提肌腱膜纤维的走行。采用描述性病例系列研究方法,于2021年2月至2022年2月从南昌大学第一附属医院门诊按照入选标准前瞻性选择患者,行上睑提肌腱膜纤维瓣法重睑成形术。术中分离上睑提肌腱膜纤维瓣,重置于切口上下唇眼轮匝肌之间,采用三层多面缝合固定的方式关闭术区,即切口下唇眼轮匝肌与上睑提肌腱膜纤维瓣根部及睑板上缘缝合固定,切口上下唇眼轮匝肌与上睑提肌腱膜纤维瓣末端缝合固定,皮肤与眼轮匝肌、上睑提肌腱膜纤维瓣末端缝合固定。术后对重睑切口愈合情况及并发症情况进行观察。术后12个月,由2名不参与手术的中级以上整形外科医生共同评估重睑形态,包括重睑线高度及弧度、双侧重睑对称性、重睑切口瘢痕等;术后12个月,由患者本人对重睑术后效果进行满意度评估,分为满意、较满意、不满意3个等级。结果5侧上睑组织标本Masson染色结果显示,单睑者上睑提肌腱膜于白线处发散成纤维状,松散地穿过眼轮匝肌,延展至睑缘皮肤层。临床上共纳入40例女性单睑或隐匿性重睑患者,年龄18~38岁。术后随访12个月,所有患者重睑切口愈合良好,未发生眼睑外翻、局部感染、线结外露、眼睑闭合不全、多重睑等并发症。术后12个月,医生对重睑形态评估结果:40例患者重睑线高度合适、弧度流畅自然;38例重睑线保持良好,2例重睑线变浅;39例双侧重睑对称性良好,1例重睑不对称;40例患者闭眼时重睑切口处无凹陷性瘢痕。术后12个月,患者对手术效果评估结果:满意35例,较满意2例,不满意3例,满意率为92.5%(37/40)。结论上睑提肌腱膜纤维瓣�ObjectiveTo explore the clinical application effect of double eyelid plasty using the levator palpebrae superioris aponeurosis fiber flap.MethodsIn March 2021,3-mm-wide tissue strips were vertically harvested from the mid-upper eyelids from 5 adult Han cadavers with single eyelids,provided by the Anatomy Lab of Nanchang Vocational Health College,and then Masson staining was performed to track the levator aponeurosis fiber.A descriptive case series study was performed.From February 2021 to February 2022,eligible patients who were prospectively collected from the Outpatient Department of the First Affiliated Hospital of Nanchang University underwent double eyelid plasty.The levator palpebrae superioris aponeurosis fiber flap was dissected and repositioned between the orbicularis oculi muscles at the upper and lower edge of incision.The surgical site was closed by a three-layer multi-faceted suture fixation:the muscle of orbicularis oculi at lower edge of incision was sutured to the flap root and tarsal upper edge;the upper and the muscle of orbicularis oculi at the upper and lower edge were sutured to the flap end;the skin was sutured to the muscle of orbicularis oculi and flap end.Postoperatively,incision healing and complications were monitored.Twelve months after surgery,two independent attending plastic surgeons evaluated double eyelid height,curvature,symmetry,and incision scar.The patients were asked to evaluate the effect as satisfied,relatively satisfied,or dissatisfied.ResultsMasson staining of 5 lateral upper eyelid specimens revealed that in single-eyelid cases,the levator palpebrae superioris aponeurosis diverged into fibers at the white line,penetrated the orbicularis oculi loosely,and extended to the eyelid margin.Fourty female patients with single or hidden double eyelids were included,aged 18-38 years.After 12 months’follow-up,all patients had good incision healing without major complications.Twelve months after the operation,the result of doctor evaluation was as followed:40 cases had proper line

关 键 词：眼睑成形术 重睑成形术 上睑提肌腱膜纤维瓣 

分 类 号：R779.6[医药卫生—眼科]