眼睑皮肤松弛症及其伴发畸形的手术整复

Surgical treatment of patients with blepharochalasis and its associated abnormalities

目的评价眼睑皮肤松弛症及其伴发畸形的手术整复效果。设计回顾性病例系列。研究对象35例(52眼)眼睑皮肤松弛症稳定期患者。方法所有患者实施上睑畸形矫正术,做上睑重睑切口,切除多余松弛皮肤及眶脂肪,18例(36眼)联合行泪腺脱垂复位术;10例(16眼)联合上睑下垂矫正术。4例(6眼)行下睑退缩矫正术。7例(14眼)行外眦畸形矫正术,联合或二期行眼睑皮肤松弛矫正或上睑下垂矫正术。主要指标双眼重睑形态,眼睑位置,眼睑运动功能,泪腺的位置,有无泪液分泌异常。结果随访6～60个月,所有患者双眼上睑重睑基本对称,双上睑形态良好,眦角位置接近正常,无溢泪及干眼症状。2例(3眼)患者于术后29及36个月复诊时发现泪腺脱垂复发,再次行泪腺脱垂复位术,术后分别随访18、24个月,未发现泪腺再脱垂。结论采用眼部整复手术矫正眼睑皮肤松弛症及伴发畸形安全有效,术后复发率较低。

Objective To assess the effects of surgical treatment for patients with blepharochalasis and its associated abnormalities. Design Retrospective case series. Participants 35 cases （52 eyes） with blepharochalasis in stable phase. Methods The correction of the abnormalities in upper eyelids： after designing the lid crease incision, the redundant eyelid skin and prolapsed fat were excised, and prolapsed lacrimal glands were sutured back into position in 18 cases （36 eyes） and ptosis was treated in 10 cases （16 eyes）. The correction of abnormalities in lower eyelids： lower eyelid retraction was corrected in 4 cases （6 eyes）. The correction of lateral canthus malformation： lateral canthus rounding was treated in 7 cases （14 eyes）, accompanied with or followed by correction of baggy eyelid or ptosis. Main Outcome Measures The shape, location and movement of bilateral eyelids, the location of lacrimal glands and the circumstance of tear secretion. Results During the follow-up of 6-60 months, the appearance and location of bilateral eyelids and canthuses were satisfying, the function of eyelids were normal, and no dry eye symptoms were found. Two cases （3 eyes） appeared recurrent lacrimal gland prolapse 29 and 36 months postoperation and received surgeries for correction again. There was no recurrence after the second prolapse correction surgery in the follow-up of 18 and 24 months respectively. Conclusions Surgical treatment for patients with blepharochalasis and its associated abnormalities is safe and effective. Its recurrence rate is low.