眼座暴露筋膜结膜瓣滑行修补的疗效及其术后上睑下垂的处理

Ptosis after sub-conjunctival and conjunctival flap repairing exposure of orbital implants

目的 探讨筋膜结膜瓣滑行修补眼座暴露手术的疗效及其术后上睑下垂发生的原因和治疗方法。方法 对2003年3月至2005年9月在上海交通大学医学院附属第九人民医院眼科因眼座暴露行筋膜结膜瓣滑行修补术的43例患者进行回顾性分析。结果 43例患者中,轻度暴露（≤5mm）5例,术后无上睑下垂发生;中度暴露（6～10mm）26例,术后6例发生上睑下垂;重度暴露（〉10mm）12例,术后4例发生上睑下垂。其中,提上睑肌肌力为4～10mm的轻中度下垂6例,应用提上睑肌修补及缩短术治疗;提上睑肌肌力为0～3mm的重度下垂4例,采用额肌瓣悬吊术矫正。上睑下垂术后随访3-6月,10例上睑下垂完全矫正,效果满意。结论 筋膜结膜瓣滑行修补术中提上睑肌腱膜的损伤是术后上睑下垂发生的主要原因;应用提上睑肌手术以及额肌瓣悬吊术治疗上睑下垂可获得满意疗效。

Objective To evaluate the occurrence and treatment of ptosis after sub-conjunctival and conjunctival flap repairing exposure of orbital implants. Methods We analyzed retrospectively 43 patients who accepted sub-conjunctival and conjunctival flap repairing exposure of orbital implants from Mar 2003 to Sept 2005 in our hospital. Results 43 patients were divided into three groups according the range of exposure. There were 5 patients in mild exposure group（ 〈 5mm）,and no ptosis complication occured. The moderate exposure group（6-10mm）had 26 patients,and 6 patients had ptosis postoperatively. The severe exposure group （〉10mm）had 12 patients,and 4 patients had ptosis postoperatively. Among the 10 cases with ptosis, 6 of these whose loevator function was greater than 4-5mm required levator muscle resectioning.The other 4 case whose levator funetion was pooler than 3-4mm required the foutalis muscle suspension. Conclusions The ptosis complication in these 10 patients postoperatively all caused by injury of the levator.; the levator muscle resectioning and the foutalis muscle suspension are the effective methods for treating these ptosis.