提上睑肌缩短术治疗重度先天性上睑下垂

Recession of levator palpebrae superioris for severe congenital lapsus palpebrae superioris

目的:探讨采用提上睑肌缩短术治疗重度先天性上睑下垂的效果及可行性。方法:对30例(34眼)患重度先天性上睑下垂患者,分别在局麻下行经皮肤面的提上睑肌缩短术,术前均进行详细的检查以除外垂直肌麻痹,jew-wink现象,重症肌无力等,bell(+)现象,上睑下垂程度用berke法:均>4mm以上,提上睑肌功能均<4mm以下,缩短量为18～24mm。结果:30例(34眼)重度先天性上睑下垂患者经用提上睑肌缩短术治疗均获满意效果,上睑缘位于角膜缘下1～3mm,双侧睑裂大小,重睑高度基本一致,睑缘弧度自然流畅,睑闭合无角膜暴露,皱额耸眉姿态消失,随诊0.5～3a,效果满意。结论:经皮肤面的提上睑肌缩短术术野暴露好,可最大限度的充分游离提上睑肌,且年龄小,肌肉弹性好,矫正度数大,可以矫正重度先天性上睑下垂,且效果确实,可行。

AIM: To evaluate the effect and feasibility of recession of levator palpebrae superioris in treating severe congenital lapsus palpebrae superioris.· METHODS: A total of 30 cases (34 eyes) of severe congenital lapsus palpebrae superioris (male 22 cases, female 8 cases; unilateral 26 cases, bilateral 4 cases) underwent transdermal recession of levator palpebrae superioris after local anaesthesia. Particular examinations were performed before surgery to exclude vertical muscle paralysis, Jew-wink, muasthenia gravis, etc. Measured by Berke's standard, the degrees of lapsus palpebrae superioris were 4mm or higher, and those of levator palpebrae superioris were lower than 4mm, the recession degree ranging from 18 to 24mm. · RESULTS: All cases achieved satisfactory effects after surgery. The upper palpebral margin was 1-3mm lower than limbus corneae and became natural, the follow-up being 0.5-3a.· CONCLUSION: Transdermal recession of levator palpebrae superioris is an efficient and satisfactory surgery for lapsus palpebrae superioris.