改良上睑提肌缩短术治疗中度和重度上睑下垂

Modified shortening of levator palpebrae superioris muscle for moderate and severe congenital blepharoptosis

目的探讨应用改良上睑提肌缩短术治疗中、重度先天性上睑下垂的疗效。方法对30例中、重度先天性上睑下垂患者（包括2例上睑下垂术后欠矫和复发患者），采用联合睑板切除的上睑提肌缩短术。术中睑板切除量根据睑板的宽度设计，上睑提肌切除量=（上提量-睑板切除宽度）×（4～5）mm。并分离睑结膜和上睑提肌，切除一定量的睑结膜以防止结膜脱垂，对术后效果进行随访观察。结果30例除3例矫正不足外，余均获得良好上提效果，上睑缘弧度自然，无严重并发症，仅少数患者早期有轻度睑裂闭合不全。结论改良上睑提肌缩短术适用于中、重度先天性上睑下垂患者及上睑下垂术后欠矫的患者，在矫正畸形和改善外观方面均能达到良好的效果。掌握手术操作要点，有助于在功能和外形上取得满意效果。

Objective To discuss the effect of an advanced technique by shortening the levator palpebrae superioris muscle in treatment of moderate and severe congenital blepharoptosis. Methods 30 cases of moderate and severe blepharoptosis （ including 2 cases of recurrent ptosis） were treated by shortening the levator palpebrae superioris associated with resection of tarsus. Removal portion of tarsus and levator palpebrae superioris muscle was designed according to the width of tarsus and the severity of blepharoptosis. Tarsus and levator palpebrae superioris muscle and conjunctiva palpebrae were resected on the basis of above design. The results of postoperation were followed up. Results Among the 30 cases, except for undercorrection in 3 cases, all others had a good outcome. Eyelid was raised to normal level by this technique with a natural eyelid contour. Only some presented a slight dysraphism in the early stage of postoperation, and no other severe complications occurred. Conclusions Shortening of the levator palpebrae superioris muscle can be applied to treat moderate and severe congenital blepharoptosis, and correct the deformity and achieve cosmetic effect simultaneously. In order to achieve satisfactory effects on function and shape, we should master the main points of operation.