提上睑肌短缩术矫治重度上睑下垂临床分析

Analysis of application of levator muscle resection on severe blepharoptosis patients

目的证明提上睑肌短缩术治疗重度上睑下垂的可行性及疗效，并与其他手术方法进行比较，为临床选择合理手术方法提供理论及临床依据。方法将32例已施行上睑下垂手术的病人按照不同的手术方式分为：提上睑肌短缩术组24例、额肌瓣悬吊术组8例。通过上睑下垂矫正术后上睑缘位置、眼睑闭合程度、上睑迟滞现象及暴露性角膜炎的发生情况，对病人进行至少6个月的随访观察，比较各组的手术疗效。结果提上睑肌短缩术组治愈率与额肌筋膜瓣悬吊术组差异无统计学意义（P〉0．05），其上睑迟滞及其他并发症发生率均低于额肌筋膜瓣悬吊术组（P〈0．05）。结论对于肌弹性15mm以上的重度上睑下垂患者，提上睑肌短缩术效果优于额肌筋膜瓣悬吊术的手术方法，能达到既符合眼睑生理功能，又改善美观的效果。

Objective To prove the feasibility and curative effect of levator muscle resection, and to compare it with other operative methods, to offer both theoretical and clinical evidence to clinical works. Methods According to operation methods, the patients were divided into 2 groups, 24 （29 eyes） had gone through levator muscle resection, while the other 8 （9 eyes） had frontal muscle ventrofixation. The patients were observed for 6 months at least, and compared the effect of operation according to palpebra superior location after operation, palpebral fissure hysteresis, palpebra superior dysraphism and exposure keratitis. Results In group that was done shortening operation, after 6 months, the incidence of insufficient rectification and hysteresis of upper eyelid was lower than that of ven- trofixation. Meanwhile, success rate of operation after 6 months in former group was similar to that of latter one. Conclusions If elasticity of levator muscle is more than 15mm, levator muscle resection is suitable to severe congenital ptosis; shortening operation shows superiority over the operative method of frontal muscle fascial flap, by recovering physiological function of eyelid and improving the outlook.