重睑成形术后发生上睑下垂的原因分析及其防治

Clinical analysis,early precaution and treatment of blepharoptosis in double eyelid operation

目的探讨重睑术后发生上睑下垂的原因及早期防治方法,避免术后医疗纠纷的发生。方法对拟做重睑术的患者,术前详细询问病史并认真查体。对18例术前发现有睁眼乏力或轻度上睑下垂者,采用切开法重睑术并同时行上睑提肌缩短术,对3例切开法重睑成形术后,出现上睑下垂并发症者即刻打开切口行上睑提肌缩短术;对5例埋线法术后出现上睑下垂者在7d内拆除缝线,重新设计重睑线。无论切开法或埋线法,如超过10d即均在3个月后再行切开法重睑成形术。结果对26例术前存在或术后发现的轻度上睑下垂者重行手术修复,24例随访3个月至2年,医者与受术者双方满意或基本满意。结论只要遵循预防为主、早期发现、早期治疗的原则,重睑成形术后出现上睑下垂这一特殊并发症是可以治愈的。

Objective To evaluate the reasons of blepharoptosis found after double eyelid operation, and the way of early precaution and treatment in order to avoid the medical dispute. Methods Case history was collected and physical examination was carefully performed before operation for patients who accepted blepharoplasty. 18 patients with debilitation of opening eyes or mild blepharoptosis were told that it might have different results from normal ones and even complications likely to be happened. Bilateral palpebral fissure and double eyelids were checked by holding patients in sitting posture after operation. In the 8 cases with the complications after operation, sectioning method was used to open the incision immediately, to repair the aponeurosis of levator palpebrae superioris and to shorten the apertor oculi; Suture was eliminated within 7 days for the 5 patients who accepted the burying thread procedure, and width of eyelids was diminished before resuture. It should be repaired after 3 months if exceeding 10 days of operation no matter which method was used. Results Among 26 patients with mild blepharoptosis before or after operation who applied for surgical revision, 24 cases were followed-up for 3 months to 2 years, both patients and the doctors were satisfied with the results or generally accepted. Conclusion The special complication of blepharoptosis in the double eyelid operation can be prevented, if we follow the principle of primary precaution, early discovery, and early treatment.