下睑成形术术式选择：10年经验体会

The 10 years experience in operative choice of blepharoplasty of lower eyelid

目的探讨适合中国人的下睑成形术术式选择标准。方法自1998年至2008年，对2400例患者采用四种不同术式行下睑成形术，包括传统的经皮皮瓣法下睑成形术（n=862），经皮肌皮瓣法下睑成形术（n=738），经结膜下睑成形术（n=433），以及Hamra的眶隔重置技术（n=367）。结果本组2400例患者术均Ⅰ期愈合，925例患者获随访1个月至10年，95％患者对手术效果满意。并发症：下睑退缩20例，下睑外翻5例，下睑凹陷5例，干眼症2例。结论经结膜入路下睑成形术是原发性睑袋患者的首选术式。经皮下睑成形术（皮瓣法或肌皮瓣法）适合于皮肤和肌肉松弛的患者。对于眼睑的支持结构（皮肤、肌肉和眶隔）松弛，或伴泪槽畸形的患者，应实施Hamra的眶隔重置技术。

Objective To explore the selective standards of operative methods for blepharoplasty of lower eyelid. Methods Frnm 1998 to 2008, 2400 patients were performed blepharoplasty of lower eyelid by four different methods, including the traditional transcutaneous skin flap procedure （ n = 862）, the transcotaneous skin-muscle flap procedure （ n = 738） , the transconjunctival procedure （ n = 433 ） and Hamra＇s procedure （septal reset and fatreplacing technique） （ n =367）. Results All 2400 patients healed primarily, and 925 patients were followed up for 1 month to l0 years. Most of the patients were satisfied with the results （95%） , but 32 patients had some postoperative complications, including ectropion （5 cases） , 5 with hollow eyes （5 ca- ses） , xeroma （2 cases） , and retraction （20 cases）. Conclusion Transconjunctival blepharoplasty is the first choice for primary eyelid bags. Transcutaneous lower blepharoplasty （skin flap or myocutaneous flap procedures） is indicated for the senile eyelid with excess of skin and muscles. For the loosening supporting structures （skin, muscle, and septum） with or without the tear trough deformity, Hamra＇s procedure （septal reset and fat-replacing technique） is performed.