全身麻醉下额肌瓣悬吊治疗小儿单眼重度先天性上睑下垂

Frontal-muscle-flap-suspending procedure under general anesthesia for the treatment of single-eye severe congenital ptosis in children

目的:观察全身麻醉下额肌瓣悬吊术治疗小儿单眼重度先天性上睑下垂的临床效果和特点。方法:对23例小儿单眼重度先天性上睑下垂行全身麻醉下额肌瓣悬吊术,男13例,女10例,2.5～7(平均4.6)岁,患眼提上睑肌力2～4(平均3.1)mm;术前确定健眼平视前方时上睑缘的位置(在上提患眼睑缘至与对侧眼等高时)。术中根据全身麻醉下眼位略上转的状态及术前健眼上睑缘的位置,将患眼睑缘上提至上角巩缘以下1～3mm。结果:随访1wk～1a,20例(87%)双眼睑缘完全或基本等高(双眼上睑缘高度差在1mm内),3例(13%)欠矫,双眼睑缘高相差约2～3mm。所有病例外观术后均较术前有明显改善或改善,均无严重的睑缘畸形、睑外翻和暴露性角膜炎等并发症,但有6例患儿术后外侧睑缘稍低,与对侧眼略不对称。结论:全身麻醉下额肌瓣悬吊术治疗小儿单眼重度先天性上睑下垂关键在于术前确定健眼上睑缘的位置,并根据术中实际眼位的变化确定上睑缘上提的量。

AIM： To observe the effects and characteristics of frontal-muscle-flap-suspending procedure under general anesthesia for the treatment of single-eye severe congenital ptosis in children. METHODS： Twenty-three children （13 boys, 10 girls, aged 2.5-7, mean 4.6） with single-eye severe congenital ptosis underwent frontal-muscle-flap-suspending surgery under general anesthesia. The myodynamia of levator muscle of upper eyelid was between 2-4mm （mean 3. 1mm）. Before surgery, the upper lid margin position of the healthy eye was confirmed when the children was staring straight forward. Palpebral margin of the eye with disease was elevated to 1-3mm under upper corneal scleral rims according to vergens sursum condition and the position of upper eyelid rims of healthy eyes under general anesthesia. RESULTS： The follow-up lasted for 1week to 1year, 20 cases （87%）got equal height for two upper lid margins （the difference between two eyes was not bigger than lmm）. 3 cases （13%）got insufficient rectify, and the difference of the two lid margins was about 2-3mm. All cases had obviously better expressions than those before operation. There were no severe complications such as ectropion, malformed upper lid margins, exposure keratoiditis et al. But there were 6 cases with slightly lower lateral-upper-margin which was asymmetric to the fellow eye.CONCLUSION： Frontal-muscle-flap-suspending procedure under general anesthesia for the treatment of single-eye severe congenital ptosis in children has two key-points： determining the position of upper lid margin and the degree of elevation of upper eyelid margin according to the changing of the position of eye.