【摘要】：目的 分析Marcus-Gunn患者的臨床特點(diǎn),評(píng)估提上瞼肌切除聯(lián)合自體闊筋膜額肌懸吊手術(shù)治療Marcus-Gunn綜合征的臨床效果。 設(shè)計(jì) 回顧性病例研究 方法 對(duì)浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院眼科中心2009年7月至2012年12月間收治的12例(12眼)Marcus-Gunn綜合征患者的病例資料進(jìn)行臨床特點(diǎn)分析,進(jìn)行術(shù)前評(píng)估,對(duì)患者行患側(cè)提上瞼肌切除聯(lián)合同側(cè)自體闊筋膜額肌懸吊手術(shù)(術(shù)前已對(duì)患有弱視及垂直性斜視患者進(jìn)行評(píng)估及矯正治療),術(shù)后進(jìn)行隨訪,評(píng)價(jià)其手術(shù)治療效果。 結(jié)果 12例患者性別無(wú)統(tǒng)計(jì)學(xué)差異(男性4例,女性8例,p=0.248),眼別無(wú)統(tǒng)計(jì)學(xué)差異(右眼7例,左眼5例,p=0.564)。無(wú)家族史。手術(shù)時(shí)患者年齡4-39歲,平均年齡14.4歲。兒童患者7例,年齡4-12歲,平均年齡7.4歲。成人患者5例,年齡16～39歲,平均年齡24.2歲。12例患者術(shù)前患眼裸眼視力為0.04～1.0。弱視1例(8.3%),屈光參差2例(16.7%),斜視1例(8.3%)。12例患者術(shù)前健眼平均瞼裂高度為8.75±0.45mm(8.0～9.0mm),患眼平均瞼裂高度為4.42±1.08mm (3.0～7.0mm).患側(cè)上瞼下垂為4.33±1.07mm(2.0～6.0mm)。上瞼聯(lián)動(dòng)幅度為2.0-7.0mm,平均4.67±1.44mm�；佳燮骄嵘喜�肌肌力為3.33±1.50mm(2.0-7.0mm)。 術(shù)后隨訪5月～45月,平均隨訪期為23.3個(gè)月。所有患者雙側(cè)瞼裂高度對(duì)稱,弧度自然,患眼平均瞼裂高度為8.58±0.79mm(7.0～10.0mm),外觀較術(shù)前明顯改善。術(shù)后10/12例(83.3%)患者張口及咀嚼時(shí)上瞼下頜聯(lián)動(dòng)現(xiàn)象完全解除,2/12例(16.7%)患者殘余1.Omm聯(lián)動(dòng)。1/12例(8.3%)患者欠矯。4/12例(33.3%)患者術(shù)眼有輕度閉合不全,其中2例在術(shù)后半年內(nèi)恢復(fù)。1例(8.3%)患者因上瞼遲滯明顯要求行二次手術(shù)治療,行闊筋膜松解術(shù)后上瞼遲滯明顯改善。無(wú)暴露性角膜炎、瞼內(nèi)翻、結(jié)膜脫垂、上瞼下垂復(fù)發(fā)等并發(fā)癥出現(xiàn)。隨訪期末,9/12例(75%)患者表示對(duì)手術(shù)效果滿意,3/12例(25%)患者較滿意。 結(jié)論 有求治欲望的Marcus-Gunn綜合征患者大多需要手術(shù)治療。單側(cè)提上瞼肌切除聯(lián)合同側(cè)自體闊筋膜額肌懸吊手術(shù)具有操作簡(jiǎn)單、組織損傷小、療效確切、術(shù)后外觀美觀、并發(fā)癥少等優(yōu)點(diǎn),是治療Marcus-Gunn綜合征的理想手術(shù)方式。
[Abstract]:Objective to analyze the clinical features of patients with Marcus-Gunn and evaluate the clinical effect of levator palpebral muscle resection combined with self-suspension of frontal fascia lata in the treatment of Marcus-Gunn syndrome. Design retrospective case study methods the clinical data of 12 patients (12 eyes) with Marcus-Gunn syndrome admitted to the Ophthalmology Center of the second affiliated Hospital of Medical College of Zhejiang University from July 2009 to December 2012 were designed. To analyze the clinical features, The patients were evaluated pre-operatively and underwent levator muscle resection combined with ipsilateral levator fascia frontalis suspension operation (the patients with amblyopia and vertical strabismus were evaluated and corrected before the operation) and followed up after the operation. To evaluate the effect of surgical treatment. Results there was no significant difference in sex among 12 patients (M 4, F 8, p = 0.248). There was no significant difference between eyes (right eye 7 cases, left eye 5 cases, p = 0.564). No family history. The patients were 4 years old and 39 years old, with an average age of 14.4 years. There were 7 children with an average age of 7.4 years (4-12 years old). There were 5 adult patients aged 16 to 39 years with an average age of 24. 2 years. The preoperative naked visual acuity of 12 patients was 0. 04. 0. 0. 0. 0. 0. 0. 0. 0. 4%. Amblyopia was found in 1 case (8.3%), anisometropia in 2 cases (16.7%) and strabismus in 1 case (8.3%). The mean height of palpebral fissure in 12 cases was 8.75 鹵0.45mm (8.0~9.0mm). The average height of palpebral fissure was 4.42 鹵1.08mm (3.0~7.0mm). The ptosis of the affected side was 4.33 鹵1.07 mm (2.0~6.0mm). The range of upper eyelid linkage was 2.0 鹵7.0mm, with an average of 4.67 鹵1.44mm. The average muscle strength of levator palpebrae was 3.33 鹵1.50 mm (2.0-7.0mm). The follow-up period ranged from 5 months to 45 months, with an average follow-up period of 23.3 months. The average palpebral fissure height was 8.58 鹵0.79mm (7.0~10.0mm). The appearance of bilateral palpebral fissure was significantly improved compared with that before operation. In 12 patients (83. 3%), the movement of upper eyelid and mandible was completely relieved during opening and mastication 10 months after operation. (2) residual 1.Omm linkage was found in 12 cases (16.7%), under correction in 12 cases (8.3%) and mild insufficiency in 12 cases (33.3%). Among them, 2 cases recovered within half a year after operation, and 1 case (8.3%) was treated with secondary operation because of upper eyelid hysteresis, and the upper eyelid hysteresis was obviously improved after fascia latissima release. No exposure keratitis, ectropion, conjunctival prolapse, recurrence of blepharoptosis and other complications occurred. At the end of follow-up, 12 patients (75%) were satisfied with the operation, and 12 patients (25%) were satisfied with the operation. Conclusion most of the patients with Marcus-Gunn syndrome need surgical treatment. Unilateral levator palpebral muscle resection combined with ipsilateral autogenous frontalis latissima muscle suspension operation has the advantages of simple operation, small tissue injury, definite curative effect, beautiful appearance and few complications after operation. It is an ideal surgical method for treatment of Marcus-Gunn syndrome.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R779.6

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