不同术式矫正儿童下睑倒睫的临床观察

Clinical observation on different operation methods for children's trichiasis correction

目的探讨不同的手术方式对儿童下睑倒睫的疗效。方法选择3～9岁的儿童28例(53只眼)。其中3例(6只眼)为双行睫患儿,另有4只眼为缝线法术后复发。大部分全麻下手术,个别配合的儿童局麻手术。8只眼行缝线法矫正;39只眼采用切开法矫正;双行睫6只眼下睑行显微镜下射频刀毛囊破坏术。结果术后下睑倒睫矫正,配合局部药物治疗角膜上皮损伤24～72 h愈合。术后随访2～3个月,有8只眼复发,其中缝线法2只眼,双行睫6只眼均有不同程度(1～4根)倒睫复发。结论应根据病情选择不同术式矫正下睑倒睫,缝线法可用于轻度倒睫者;切开法适用绝大多数下睑倒睫,且术后无复发;对于双行睫者,射频刀毛囊破坏术疗效显著,值得在临床上推广应用。

Objective To study the outcome of different surgical procedures for children＇s trichiasis correction. Methods A study was carried out on 28 children （53 eyes） with trichiasis at the Shanghai Ninth Pcople＇s Hospital. The range of age was 3 to 9 years old. Of these eases, three （ 6 eyes ） were distiehiasis ; four eyes were triehiasis that recurred after previous suturing. Most of the surgeries were performed under general anesthesiaI unless the patient was able to be co- operative. In the latter ease, local anesthesia was used. Eight eyes underwent suturing; thirty-nine eyes underwent inci- sions; six distichiasis eyes （ 12 eyelids） were treated with hair follicle destruction with a radio frequency { RF） knife under a microscope. Results All triehiasis were corrected. Corneal epithelium healed in 24 - 72 hours with the use of tropical medications. Trichiasis recurred in 8 eyes after 2-3 months＇follow-up. Among these recurred eases, 2 eyes had been trea- ted with suturing, and the other 6 eyes were distiehiasis. Conduslon The procedures to correct triehiasis should be cho- sen according to the severity of triehiasis. Suturing is only appropriate for mild cases; while incision could be chosen for most children. Incision can effectively correct trichiasis and hardly causes recurrence. Destruction of hair follicles with a RF knife yields satisfactory results in children with distichiasis and is recommended.