【摘要】：目的:介紹一種保留懸吊系統(tǒng)的提上瞼肌縮短術(shù)矯正先天性上瞼下垂的手術(shù)技術(shù),為上瞼下垂尋求更佳的手術(shù)方法,并達(dá)到功能和美學(xué)的雙重效果。資料與方法:研究吉大二院眼科醫(yī)院自2014年10月至2016年4月先天性上瞼下垂患者90例(132只眼),其中輕度10例(14只眼),中度50例(68只眼),重度30例(50只眼)。術(shù)前行提上瞼肌肌力、瞼裂高度以及下垂程度等上瞼下垂相關(guān)檢查,排除手術(shù)禁忌,由重瞼切口入路單純從結(jié)膜固有層面分離Müller’s肌和提上瞼肌復(fù)合組織瓣至合適位置,術(shù)中采取保留提上瞼肌懸吊系統(tǒng),然后將復(fù)合組織瓣相應(yīng)位置與瞼板上1/3位置固定縫合,術(shù)中每矯正1mm的下垂量縮短提上瞼肌2-3mm。術(shù)后隨訪1周、1個(gè)月、6個(gè)月,觀察術(shù)后上瞼緣高度、眼瞼形態(tài)、眼瞼閉合程度、雙眼對(duì)稱(chēng)性以及暴露性角膜炎的發(fā)生情況及患者滿(mǎn)意度。結(jié)果:術(shù)后1周,所有患者眼瞼腫脹基本消失,上瞼緣位于上方角膜緣下0-2mm。輕、中度上瞼下垂患者眼瞼閉合良好,重度患者眼瞼閉合有不同程度鞏膜暴露度。術(shù)后1月,輕、中度患者上瞼緣位置保持良好,位于角膜緣下方1-2mm,眼瞼均能基本閉合完全。部分重度患者上瞼緣高度稍有下降,但眼瞼閉合程度較前明顯改善。隨訪至6個(gè)月,輕、中度患者上瞼緣位置仍穩(wěn)定在角膜緣下1-2mm,眼瞼均閉合自如。重度患者中,18例患者(34只眼)上瞼緣位于角膜緣下1-2mm,12例患者(16只眼)位于角膜緣下2-4mm。大多數(shù)重度患者達(dá)到1至2度閉合,4例患者3度閉合。隨訪期間,無(wú)一例暴露性角膜炎發(fā)生,眼瞼飽滿(mǎn),瞼緣弧度良好,雙眼對(duì)稱(chēng)或基本對(duì)稱(chēng),患者滿(mǎn)意度高。結(jié)論:保留懸吊系統(tǒng)的提上瞼肌縮短術(shù)不破壞眼瞼重要的解剖結(jié)構(gòu),節(jié)省提上瞼肌縮短量,不僅手術(shù)損傷小,而且術(shù)后眼瞼閉眼功能及形態(tài)恢復(fù)好,特別對(duì)于輕、中度上瞼下垂可以達(dá)到最佳術(shù)后效果。
[Abstract]:Objective: to introduce a surgical technique of levator muscle shortening to correct congenital ptosis with suspending system, and to find a better operative method for blepharoptosis, and to achieve the dual effect of function and aesthetics. Materials and methods: from October 2014 to April 2016, 90 patients (132 eyes) with congenital blepharoptosis were studied, including 10 mild cases (14 eyes), 50 moderate cases (68 eyes) and 30 severe cases (50 eyes). The muscle strength of levator palpebrae muscle, the height of palpebral fissure and the degree of ptosis were examined before operation, and the surgical contraindication was eliminated. M 眉 ller's muscle and levator palpebral muscle composite tissue flap were separated from conjunctival inherent layer to proper position by double eyelid incision approach. The suspension system of levator palpebrae muscle was preserved during the operation, then the corresponding position of the composite tissue flap was fixed and sutured with the position of 1 / 3 of the upper eyelid plate. The sagging amount of 1mm was shortened by 2 to 3 mm. for each correction of 1mm during the operation. All patients were followed up for 1 week, 1 month and 6 months. The height of upper eyelid, the shape of eyelid, the degree of eyelid closure, the symmetry of both eyes, the occurrence of exposed keratitis and the satisfaction of the patients were observed. Results: at 1 week after operation, eyelid swelling disappeared in all patients, and the upper eyelid limbus was located 0-2 mm below the upper limbus cornea. Patients with mild and moderate blepharoptosis had good eyelid closure and severe blepharoptosis had different degree of scleral exposure. At 1 month after operation, the upper palpebral margin of mild and moderate patients remained well, 1-2 mm below the limbus cornea, and the eyelids were almost completely closed. In some severe patients, the height of upper eyelid edge decreased slightly, but the degree of eyelid closure was improved obviously. Follow-up to 6 months showed that the upper palpebral margin remained stable at 1-2 mm below the corneal limbus in mild and moderate patients, and the eyelids were closed freely. Of the 18 patients (34 eyes), the upper eyelid limbus was located at 1-2mm below the limbus cornea. 12 patients (16 eyes) were located 2-4 mm below the limbus cornea. Most severe patients had 1 to 2 degree closure and 4 patients had 3 degree closure. During the follow-up, no exposed keratitis occurred, the eyelid was full, the margin of eyelid was good, the eyes were symmetrical or basically symmetrical, and the satisfaction of the patients was high. Conclusion: the levator muscle shortening with suspension system does not destroy the important anatomical structure of eyelid, save the shortening of levator palpebral muscle, not only has little operation injury, but also the function and shape of eyelid closure after operation, especially for light. Moderate blepharoptosis can achieve the best postoperative effect.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R779.6

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