上睑解剖结构及其在上睑下垂矫正术中的意义

Anatomy of the upper eyelid and its significance in correction of eyelid ptosis

目的熟悉上睑解剖结构,进一步提高上睑下垂的矫治疗效。方法近3年共治疗132例轻中度上睑下垂患者,大部分采用上睑提肌缩短或者折叠的手术方式,术中精细解剖上睑提肌肌瓣,注意勿损伤动脉弓、泪腺等结构,Whitnall韧带视情况予以切断。再按照上睑下垂的程度进行肌瓣缩短或者折叠。结果大部分病例术后矫正效果满意,3例患者矫正不足,1例患者矫正过高,2例患者重睑线不完全对称,经过进一步处理效果满意。结论按照解剖结构精细分离上睑提肌肌瓣,按照上睑下垂程度估测上睑提肌缩短的距离是成功进行上睑下垂矫正的关键。

Objective To explore anatomic features of the upper eyelid for improving clinical effect on the ptosis correction.Methods 132 patients with mild or moderate ptosis were followed up during 3 years.Most cases were treated with surgical levator shortening or folding.Levator muscle flap was dissected carefully intraoperatively,which was shortened or folded according to the degree of ptosis.The aortic arch,lacrimal gland and other important structures were protected during the operation.Whitnall ligament was cut or not according to the specific conditions.Results The correction was satisfied for most patients,except for 3 cases of under-correction,one case of over-correction,and 2 cases of asymmetrical eyelid lines.Conclusions The key process for the correction of eyelid ptosis is to isolate levator muscle flap,and evaluate the shorten degree of the levator,according to the anatomic features of the upper eyelid.