不同类型眼袋的术式选择及疗效分析

Operation patterns selection and curative effect of different types of lower eyelid blepharoplasty

目的探寻不同类型的眼袋最有效且合适的外科治疗方法,并进行疗效分析。方法收集进行眼袋整复的患者98例,其中24例为单纯眶脂肪疝眼袋,52例为下睑膨隆伴皮肤松弛型眼袋,22例为皮肤松弛伴眶下缘凹陷型眼袋,分析这三种类型手术方式、并发症的差异,并比较术后疗效。结果单纯眶脂肪疝出型眼袋结膜入路眶隔后及眶隔前入路手术的效果差异无统计学意义(χ2=0,P>0.05)。且行结膜入路切口≥1 cm时,应于内、中、外三点定位缝合结膜下组织,以利于创口对合生长。对于下脸膨隆伴皮肤松驰型患者皮瓣法术后效果优于肌皮瓣法(χ2=5.30,P<0.05)。对于重度下睑松弛患者,处理外眦可以减少术后下睑外翻、下睑退缩的发生率(P<0.05)。对于有眶下缘凹陷的患者,行Hamra术可以有效预防术后眶下缘凹陷(χ2=6.29,P<0.05)。结论不同类型的眼袋应选用不同的手术方法,增加手术成功率,减少手术创伤和并发症的发生。

Objective To find out the effective and suitable blepharoplasty for different types of lower lid bulges. Methods Datas of 98 cases of lower eyelid blepharoplasty, of which 24 cases of pseudoherniation of the orbital fat, 52 cases of pseudoherniation of the orbital fat with skin attenuate, 22 cases of skin attenuate with tear trough deformity were collected. The three types of operation and curative effect were compared and analyzed. Results There were no differences between posterior orbital septum and anterior orbital septum approach in trans conjunctival blepharoplasty （χ2=0 ,P〉0.05 ）. In trans conjunctival blepharoplasty, shoud suture the tissue under conjunctiva if the incision was larger than 1 cm to make the incision recover better. Skin flap was better than skin-muscle flap for any patients （χ2=5.30,P〈0.05）. It was necessary to do the transcantho-canthopexy for the patients whose lower lid was slack seriously （P〈0.05）. Hamra method avoided depression in infraorbital margin（χ2=6.29,P〈0.05）. Conclusions For different types of lower eyelid bulges, different operation patterns should be used to reduce trauma and complication.