【摘要】：背景：眼袋形成的原因很多,年輕患者多為遺傳因素所致眶隔脂肪肥大、增生。隨著年齡增長(zhǎng),下瞼皮膚彈性降低,眼輪匝肌退行性改變,眶隔膜張力減弱,眶內(nèi)脂肪經(jīng)眶隔的薄弱區(qū)向前推移形成突出的眼袋。此外,眶下部淺層軟組織受重力影響而向頰部下垂而使該部位軟組織變薄,形成眶下緣凹陷溝槽。傳統(tǒng)眼袋整形術(shù)一般采用經(jīng)結(jié)膜入路及經(jīng)皮膚切口入路兩種術(shù)式,以去除眶隔脂肪改善外凸畸形為主。多數(shù)年輕患者屬于下瞼脂肪突出型眼袋、皮膚彈性良好、眶瞼溝淺而窄,采用結(jié)膜入路術(shù)式去除疝出脂肪；中老年人除眼袋明顯外,常伴有皮膚松弛、眶瞼溝深而寬,從側(cè)面觀察呈現(xiàn)雙凸型,僅切除眶隔脂肪將使下瞼不平整,局部凹陷明顯,眶瞼溝更加顯露,故目前多采用Hamra設(shè)計(jì)的經(jīng)皮膚切口入路術(shù)式,保留并釋放眶隔脂肪、提緊眼輪匝肌、切除松弛皮膚。 目的：針對(duì)眶瞼溝嚴(yán)重而下瞼皮膚松弛不明顯的眼袋類(lèi)型,設(shè)計(jì)適用性較強(qiáng)的手術(shù)方法。 方法：術(shù)前應(yīng)先評(píng)估患者情況,了解患者對(duì)手術(shù)效果的期望,進(jìn)而選擇合適的經(jīng)結(jié)膜入路術(shù)式,釋放并保留眶隔脂肪的手術(shù)方法。 結(jié)果：12例眶瞼溝嚴(yán)重而下瞼皮膚松弛不明顯的眼袋患者以經(jīng)結(jié)膜入路釋放并保留眶隔脂肪術(shù)式,改善眼袋。術(shù)后經(jīng)3-6個(gè)月以上隨訪(fǎng),表明眼袋及眶、瞼溝改善明顯,無(wú)并發(fā)癥出現(xiàn)。 結(jié)論：針對(duì)眶瞼溝嚴(yán)重而下瞼皮膚松弛不明顯的眼袋類(lèi)型,采用經(jīng)結(jié)膜入路術(shù)式,釋放并保留眶隔脂肪的手術(shù)方法可以達(dá)到良好的效果。
[Abstract]:Background: there are many causes of ocular pouch formation. Young patients are mostly caused by genetic factors of orbital septum fat hypertrophy and hyperplasia. With age, lower eyelid skin elasticity decreased, orbicularis oculi muscle degeneration changes, orbital diaphragm tension weakened, intraorbital fat through the weak area of orbital septum forward to form prominent pouch. In addition, the superficial soft tissue of the lower orbital layer was caused by gravity to droop down to the buccal part, which made the soft tissue thin and formed the sag groove of the lower orbital margin. Traditional pouch surgery usually adopts transconjunctival approach and skin incision approach to improve the deformity of orbital septum fat. Most of the young patients belong to the lower eyelid fat protruding pouch, the skin elasticity is good, orbital sulcus is shallow and narrow, the conjunctival approach is used to remove hernia and fat; In addition to the obvious pouch, the middle-aged and old people are often accompanied by skin relaxation, deep and wide orbital eyelid sulcus, double convex type observed from the side, only excision of orbital septum fat will make the lower eyelid irregular, local depression obvious, orbital palpebral sulcus more exposed, At present, Hamra-designed skin incision approach is often used to preserve and release orbital septum fat, tighten orbicularis oculi muscle, and remove relaxed skin. Objective: in view of the orbital eyelid sulcus serious, the lower eyelid skin is not obvious loose eye bag type, designs the strong applicability operation method. Methods: the patient's condition should be evaluated before the operation, and the patient's expectation of the operative effect should be understood, and then the proper transconjunctival approach should be chosen to release and retain orbital septum fat. Results: the orbital pouch was improved by transconjunctival approach and the orbital septum fat was preserved in 12 patients who had serious orbital sulcus and the lower eyelid skin was not obviously relaxed. Follow-up for more than 3 months showed that the eyelid pocket, orbit and eyelid sulcus were improved obviously, and no complications occurred. Conclusion: according to the type of eyelid bag with serious orbital sulcus but the lower eyelid skin is not obviously loose, the method of transconjunctival approach to release and retain orbital septum fat can achieve a good effect. [WT5HZ] [WT5 "HZ] conclusion: [WT5" BZ]
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R779.6

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