本文選題：上瞼退縮　切入點：甲狀腺相關(guān)性眼病　出處：《上海醫(yī)學(xué)》2017年07期 　論文類型：期刊論文

【摘要】：目的探討甲狀腺相關(guān)性眼病(TAO)上瞼退縮的治療方法。方法回顧分析臨床資料完整的55例72眼TAO上瞼退縮患者的治療效果。分別采用上瞼局部注射A型肉毒桿菌毒素、Müller肌切除術(shù)聯(lián)合提上瞼肌部分切斷術(shù)、提上瞼肌-Müller肌延長術(shù)治療TAO上瞼退縮�；顒悠诨虿∏榉�(wěn)定時間6個月的靜止期患者采用上瞼注射A型肉毒桿菌毒素治療;病情穩(wěn)定時間6個月的靜止期患者中,輕度和中度上瞼退縮者采用Müller肌切除術(shù)聯(lián)合提上瞼肌部分切斷術(shù)治療,中度和重度上瞼退縮者采用提上瞼肌-Müller肌延長術(shù)治療。術(shù)畢以輕度過矯為宜。結(jié)果上瞼局部注射A型肉毒桿菌毒素治療12例15眼,治療后上瞼退縮完全消失4例5眼,明顯改善7例8眼,無效1例2眼,治療有效率為86.7%(13/15)。Müller肌切除術(shù)聯(lián)合提上瞼肌部分切斷術(shù)治療32例43眼,治療后上瞼退縮完全消失16例23眼,明顯改善11例15眼,無效5例5眼,治療有效率為88.4%(38/43)。提上瞼肌-Müller肌延長術(shù)治療11例14眼,治療后上瞼退縮完全消失7例9眼,明顯改善2例3眼,無效2例2眼,治療有效率為85.7%(12/14)。3種治療方法間治療有效率的差異均無統(tǒng)計學(xué)意義(P值均0.05)。上瞼注射A型肉毒桿菌毒素治療后欠矯1例2眼;Müller肌切除術(shù)聯(lián)合提上瞼肌部分切斷術(shù)治療后欠矯3例3眼,輕度過矯2例2眼;提上瞼肌-Müller肌延長術(shù)后欠矯1例1眼,輕度過矯1例1眼。結(jié)論 TAO上瞼退縮宜采用綜合治療措施。A型肉毒桿菌毒素治療適用于活動期患者、眼局部應(yīng)用人工淚液和眼膏難以緩解癥狀者;病情穩(wěn)定時間6個月的靜止期患者,可手術(shù)治療。
[Abstract]:Objective to investigate the treatment of upper eyelid retraction in patients with thyroid associated ophthalmopathy (TAO). Methods 55 cases (72 eyes) with TAO upper eyelid retraction with complete clinical data were retrospectively analyzed. Botulinum toxin type A was injected locally into the upper eyelid. M 眉 ller myectomy combined with partial levator blepharotomy, Levator palpebral muscle-M 眉 ller muscle lengthening was performed for the treatment of TAO upper eyelid retraction. Patients with active or stable condition at rest for 6 months were treated with Botulinum toxin A injection into the upper eyelid. Patients with mild or moderate upper eyelid retraction were treated by M 眉 ller myectomy combined with partial levator blepharotomy. The patients with moderate and severe upper eyelid retraction were treated with levator palpebral muscle M 眉 ller muscle lengthening, and mild overcorrection was performed at the end of the operation. Results Local injection of botulinum toxin A was used in 15 eyes of 12 cases and 5 eyes of 4 cases with complete disappearance of upper eyelid retraction after treatment. The effective rate was 86.7%. The effective rate was 86.7%. M 眉 ller myectomy combined with partial levator blepharotomy was used to treat 32 cases (43 eyes), 16 cases (23 eyes) disappeared completely after treatment, 11 cases (15 eyes) improved obviously, 5 cases (5 eyes) had no effect. The effective rate of treatment was 88.4% 38 / 43. The extension of levator palpebral muscle M 眉 ller muscle was performed in 14 eyes of 11 cases, 7 cases of 9 eyes disappeared completely after treatment, 2 cases 3 eyes improved obviously, 2 cases 2 eyes failed, 2 cases 2 eyes. The effective rate of treatment was 85.7 / 14.3. There was no significant difference in the effective rate of treatment among 12 / 14.3 treatments (P = 0.05). Under correction after upper eyelid injection of botulinum toxin A, 2 eyes of 1 case were treated with myectomy of M 眉 ller combined with partial resection of levator palpebri muscle. 3 cases (3 eyes) were undercorrected after treatment. There were 2 eyes with mild overcorrection, 1 case with undercorrection of levator muscle M 眉 ller muscle and 1 eye with mild overcorrection. Conclusion TAO upper eyelid retraction should be treated with botulinum toxin type A. Artificial tears and ointment were difficult to relieve the symptoms, and patients with stable condition for 6 months could be treated surgically.
【作者單位】： 上海長征醫(yī)院眼科;
【基金】：國家自然科學(xué)基金委員會青年科學(xué)基金資助項目(81400432)
【分類號】：R581;R771.3

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本文編號：1606214