眼睑黑痣的外科治疗

The surgical treatment of the nevi on eyelids

目的比较多种方法治疗眼眶部黑痣的效果。方法3例黑痣范围<1/5睑裂长度,且宽度<2mm者行眼睑黑痣直接切除缝合;8例黑痣范围1/5～1/4睑裂长度者行"V"型全层眼睑组织切除;6例黑痣范围1/4～1/2睑裂长度者,沿睑缘白线劈开,切除眼睑前叶黑痣,行局部皮瓣转移术修复;31例眼睑巨大黑痣切除后行全厚皮片移植修复。结果48例患者均获得了预期的治疗效果,眼睑形态较自然,无明显的继发畸形。移植皮片全部成活,皮片在术后短期内与周围皮肤颜色有明显差异,但随时间延长,颜色差异逐渐减轻。无睑裂闭合不全,眼睑外翻畸形发生。结论黑痣范围>1/2睑裂长度者,以手术切除植皮为主要方法;黑痣范围<1/2睑裂长度者行黑痣切除、局部皮瓣转移术修复,是较理想的治疗方法。

Objective To discuss the surgical methods of treatment of nevi on eyelids. Methods Forty - eight patients with nevi on eyelids were included in this study. 3 cases whose length of nevi scope was less than 1/5 palpebral length and width was less than 2 were excised and the wounds were sutured directly. 8 cases with nevi on eyelids in the range from 1/5 to 1/4 palpebral length were excised in V - shape and the wounds were sutured directly. 6 cases with nevi in the range from 1/4 to 1/2 palpebral length were excised and the wounds were repaired by local flaps. 31 with large area nevi were excised and the wounds were repaired by skin grafts. Results All these surgical methods received the expected effects. After operation, the appearance of eyelids was satisfying without obvious acquired malformation, skin grafts necrosis, palpebral dysraphism and valgus deformity. During the short period after operation, the color of skin grafts was obviously different from that of the surrounding skin. And in the long - term follow - up, the difference became inconspicuous. Conclusion The nevi on eyelids were more than 1/2 palpebral length, skin grafts should be more considered. The nevi whose length was less than 1/2 palpebral length were excised and the wounds were repaired by local flaps. The satisfactory results were observed by this operation technique.