伴有显著眶睑沟凹陷型睑袋的手术方法探讨

Surgical treatment of depressed baggy deformity of lower eyelid

目的探讨不同程度眶睑沟凹陷型睑袋的手术方法。方法采用内侧眶隔脂肪释放填充眶睑沟状凹陷,利用眼轮匝肌瓣与脂肪瓣结合,在眶隔与眼轮匝肌之间增加一层由脂肪和肌肉组成的复合组织作为衬垫,以增加组织厚度,弥补或缓解眼眶凹陷。结果本组42例,其中33例医患双方均满意,4例凹陷区矫正不足,5例凹陷区矫正过度,再次手术去除适量脂肪。结论被释放并下移的脂肪组织或被释放的眶隔脂肪组织和返折的眼轮匝肌充填于睑袋凹陷区,眶隔脂肪-眼轮匝肌复合组织瓣的形成加强了下眶前壁的张力,保证了眶内外的生理屏障及充填脂肪、肌肉的血供,使其在生理、解剖学方面,更趋于合理、自然,避免了术后远期内的组织因缺血退化而引起的组织退缩。

Objective To explore the methodology of surgical treatment for depressed baggy deformity of lower eyelid. Methods Intraorbital septum fat was released to fill in the trench-like depression of the baggy eyelid. By using the muscular flap of sphincter oculi and fat flap, a pad consisting of combined tissues of fat and muscles was formed between orbital septum and orbicular muscle of eye to increase the tissue thickness in order to fetch up or decrease the sunken orbit. Results 42 cases of baggy deformity of eyelid were treated with the above techniques, in which 33 cases achieved satisfactory results by both patients and doctors, 4 cases with insufficient correction of the depressed region, 5 cases with over correction and further operation needed to remove proper amount of fat. Conclusions Released fat and reflexed sphincter oculi fill in the depressed region of eyelid sack. The combined flap of intraorbital fat and sphincter oculi increases the tension of antorbital wall. These ensure the physiological barrier and blood supply of intraorbital and extraorbital tissues, which maintain more natural physiologic and anatomic functions, to avoid the tissue atrophy caused by ischemia and degeneration in the late stage of operation.