重度先天性上睑下垂的早期手术治疗

Early surgery of severe congenital ptosis of the eyelid

目的 探讨儿童重度先天性上睑下垂早期手术治疗方法。方法 采用改良的双切口提上睑肌腱膜瓣 -额肌吻合术治疗 15例 (2 2眼 )重度先天性上睑下垂合并遮蔽性弱视的患儿 ,年龄 4～ 12岁 (平均 6 5岁 )。结果 术后上睑缘高度变化具有明显规律性 ,术后早期上睑缘回落较快 ,幅度较大 ,一般在术后 1周时 ,平均下降 2 5mm ;术后 1个月时上睑缘高度又有所回升 ,平均 1mm ;术后 3个月上睑缘高度再次缓慢下降 ,直至术后半年时稳定。随访 1年 ,18眼上睑缘位于角膜缘下 1～ 2mm ,重睑和睑缘弧度自然美观 ;4眼上睑缘位于瞳孔上缘 ,重睑和睑缘弧度自然美观。术后睑裂闭合不全 ,一般在术后 3个月至半年时消失。本组病例均未发生其它术后并发症。结论 该手术方法适用于早期治疗儿童重度先天性上睑下垂。

Objective To investigate the method of early surgery for correction of severe congenital ptosis in chidren.Methods 15 cases(22 eyes) of children severe ptosis of the eyelid undertook the treatment with modified levator palpebrae superioris musculoaponeurotic flap-frontalis anastomosis.Results The significant changing regulation for the height of the upper eyelid margin postoperatively was noted.The upper lid margin dropped down quickly in early in early stage about 2 5mm averagely one week postoperatively and elevated again about 1mm averagely one month postoperatively,then dropped down slowly three month to half year postoperatively.The initial operations of all the cases were successful with good appearance cosmeticly.Conclusions This surgical procedure is suitable for correction of sever congenital ptosis in children.