两种内眦开大手术方法的临床应用分析

Clinical application analysis of two mehods in canthoplasty

目的:将两种方法内眦开大术进行比较,以便根据不同程度和类型的内眦赘皮选择相应的手术方法,使内眦开大更充分,切口瘢痕更隐蔽,形态更满意。方法:①保留部分皮肤皱襞的内眦开大术(简称术式一,下同),是在内眦定点切开后保留内眦上方皮肤皱襞不完全切开,充分游离后,与重睑线顺延缝合;②下睑缘横切口内眦开大术(简称术式二,下同)是在切开内眦赘皮后再沿下睑缘横行切开,将内眦下方堆积皮肤在睑缘方向均匀舒展后缝合。结果:本组416例,270例得到随访。其中,术式一212例,术式二58例。两种方法开大内眦,效果均满意。术式一术后瘢痕性赘皮29例,其中3例行再次修复;术式二中3例发生下睑内侧退缩,泪阜外露过多,5例形成半环形瘢痕,半年后渐淡化。结论:单纯保留皮肤皱襞的内眦开大适合轻度的患者,对中重度的患者应结合下睑缘横切口。两种方法的有机结合,使内眦上方的皮肤皱襞均匀舒展,切口瘢痕更加隐蔽。只要适应证选择合适,内眦开大充分,均能收到满意的治疗效果。

Objective Comparing of two kinds of method in canthoplasty,in order to choose the corresponding surgical method according to different degree and type of epicanthus,which make the canthoplasty more sufficient,more invisible scar,and more satisfied appearance.Methods ①Canthoplasty with remaining partial skin fold （shorted as method I）,which is to cut open canthal point with uncompleted incision of superior canthal skin fold,and then extend to double-eyelid line.②Canthoplasty with horizontal incision close to inferior eyelid （shorted as method II）,which is to add a horizontal incision near the inferior eyelid edge after cutting open the epicanthal fold,then the redundant skin of superior canthus can be spreaded uniformaly along the inferior eyelid for suturing.Results 416 cases are collected,270 cases are followed up.Among of total,method I is applied in 212 cases,method II 58 cases.The results of the two kinds of method are all satisfied.the postoperation scar-relating canthus in method I accounts for 29 cases,and 3 cases are taken reconstruction.3 cases in method II complicated with retraction at inner inferior eyelid,and excessive exposure of lacrimal caruncle,5 cases occured to semi-ring scar,which becoming invisible after 6 months.Conclutions Canthoplasty remaining skin fold simply is fit for mild epicanthus,but the correction of medial-severe epicanthus should combine with horizontal incision close to inferior eyelid.The organism combination of this two methods could spread the skin fold of superior and inferior canthus,and make the scar more hidden.So we can acquire satisfied results as long as selecting indication appropriately and canthus opening completely.