本文選題：眼瞼分裂痣　切入點：眼瞼缺損　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究目的:總結22例眼瞼分裂痣患者,手術切除后個性化美容修復繼發(fā)性眼瞼缺損的方法與體會。方法:收集2010年1月至2016年12月在我科行眼瞼分裂痣手術治療的22例患者,男性8例,女性14例,年齡在5-38歲之間,平均年齡為19.2歲,左眼10例,右眼12例。病變部位:近眼瞼內眥部10例,近眼瞼中部4例,近眼瞼外眥部8例。侵及瞼緣、結膜者8例,僅累及淺層者14例。病變面積:上瞼0.4cm×0.3cm~2.3cm×1.5cm,下瞼0.3cm×0.2cm~2.5cm×2.4cm。根據(jù)分裂痣的部位、形態(tài)、面積、深度、年齡、皮膚松弛度及缺損修復后供區(qū)的代價等多方面綜合考量設計不同的皮瓣修復繼發(fā)缺損,達到美容效果。術后隨訪1、3、6、12個月,對眼瞼對稱性、瘢痕、眼瞼活動性、眼瞼退縮、眼瞼外翻、上瞼臃腫、內、外眥角畸形、分裂痣復發(fā)、患者舒適度等術后效果進行評價(未設對照組)。結果:所有患者術后皮瓣成活良好,切口愈合良好。術后1、3、6、12個月隨訪觀察,22例患者的雙眼對稱性好,瘢痕均不明顯,眼瞼睜閉自然,無眼瞼外翻現(xiàn)象,無上瞼臃腫,分裂痣均無復發(fā),無不適感。20例患者眼瞼形態(tài)良好,1例有輕度下眼瞼退縮,行眼袋切口的下瞼退縮矯正術(外眥韌帶懸吊術),術后臨床效果滿意。1例出現(xiàn)外眥角輕度變形,瞼裂略短,但不影響眼瞼整體形態(tài)。結論:1.眼瞼分裂痣切除后眼瞼缺損的修復,首選推進皮瓣,可以在推進皮瓣的基礎上,靈活結合其他局部皮瓣進行修復。2.下眼瞼分裂痣且面積較大時,可應用眼輪匝肌為蒂的島狀皮瓣修復。3.累及瞼緣及瞼結膜者,可酌情保留瞼緣及瞼結膜,定期復查。4.各種皮瓣的設計,盡量做到輔助切口少,皮瓣轉移后切口盡量隱蔽,與瞼緣、眉毛或與皮紋線、皺紋線、輪廓線平行,以隱蔽瘢痕。5.眼瞼分裂痣的修復應根據(jù)部位、形態(tài)、面積、深度、年齡、皮膚松弛度以及缺損修復后供區(qū)的代價采取個性化設計。
[Abstract]:Objective: to summarize the method and experience of 22 cases of eyelid split nevus treated by individualized cosmetic repair after operation. Methods: from January 2010 to December 2016, 22 patients with eyelid split nevus were treated by operation in our department. Male 8 cases, female 14 cases, age 5 to 38 years old, mean age 19.2 years, left eye 10 cases, right eye 12 cases. Lesion location: proximal eyelid medial canthus 10 cases, proximal eyelid middle 4 cases, proximal eyelid outer canthus 8 cases. There were 8 cases of conjunctiva and 14 cases of superficial layer involvement. The lesion area was 0.4cm 脳 0.3cm of upper eyelid, 2.3cm 脳 1.5cm of lower eyelid, 2.5cm 脳 2.4cm of lower eyelid, according to the location, shape, area, depth, age of mitotic nevus. Different skin flaps were designed to repair the secondary defects in order to achieve cosmetic effect. The postoperative follow-up was 1: 3 for 6 months and 12 months for eyelid symmetry, scar, eyelid activity, eyelid retraction, and so on, including the skin relaxation and the cost of the donor area after repairing the defect. The postoperative effects of ectropion, bloated upper eyelid, inner and outer canthus angle malformation, recurrence of fission nevus and comfort degree of the patients were evaluated. Results: the flap survived well in all the patients. The incision healed well. All the 22 cases were followed up for 12 months. The symmetry of the eyes was good, the scar was not obvious, the eyelid was open and closed naturally, there was no eyelid ectropion, the supreme eyelid was bloated, and there was no recurrence of mitotic nevus. No discomfort. 1 case with mild lower eyelid retraction was treated with lower eyelid retraction through pouch incision (external canthus ligament suspension). The clinical results were satisfactory in 1 cases with slight deformation of the outer canthus angle and slightly short eyelid fissure. But it does not affect the overall shape of eyelid. Conclusion 1. The first choice of propelling flap is to repair eyelid defect after eyelid mitotic nevus resection, which can be combined with other local skin flap flexibly to repair lower eyelid mitotic nevus when its area is larger. The island flap pedicled with orbicularis oculi muscle can be used to repair .3.If the eyelid rim and the eyelid conjunctiva are involved, the eyelid edge and eyelid conjunctiva can be preserved, and the design of various kinds of flaps should be reviewed periodically, so as to minimize the auxiliary incision and conceal the incision after the flap transfer. Parallel to the margin of the eyelid, eyebrows or lines of skin, lines of wrinkles, contours, to conceal scar .5.The repair of mitotic nevus of the eyelid should be based on location, shape, area, depth, age, etc. The skin relaxation and the cost of the donor area after repairing the defect were individualized.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R779.6;R62

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