治疗甲状腺相关眼病上睑退缩的两种术式比较研究

Comparative study of two surgical methods for upper eyelid retraction of thyroid-associated ophthalmopathy

目的比较矫正甲状腺相关眼病上睑退缩两种术式临床疗效。方法将95例（163眼）静止期中、重度甲状腺相关眼病眼上睑退缩随机分为A、B两组。A组41例（73眼）采用上睑提肌-Mǖller肌复合体延长术；B组54例（90眼）采用上睑提肌-Mǖller肌复合体切断术。术后随访6个月，评价其临床疗效。结果A组有效率76．7％，B组有效率92．2％。术后并发症：A组不满意17眼（23．3％），其中过矫5眼（6．8％），重睑过宽8眼（10．9％），过矫和重睑过宽两者都同时存在的有4眼（5．4％），无欠矫。B组不满意7眼（7．7％），其中欠矫有4眼（4．4％），上睑外侧位置高、内侧位置低2眼（2．2％），重睑过宽1眼（1．1％）。术后6个月，B组满意率、总有效率明显好于A组，不满意率明显小于A组，两组比较差异有统计学意义（P〈0．05）。结论两种手术方法在矫正中、重度甲状腺相关眼病上睑退缩均有显著效果，且B组上睑提肌-Mǖller肌复合体切断术治疗效果优于A组。

Objective To compare two surgical methods in the management of upper eyelid retraction of thyroid-associated ophthalmopathy. Methods 95 cases （ 163 eyes） with moderate or severe upper eyelid retraction of thyroid-associated ophthalmopathy were randomly divided into two groups： group A and group B. There were 41 cases （73 eyes） in group A who underwent levator-Mtiller＇ s muscles lengthening surgery and 54 cases （90 eyes） in group B treated by levator-Mǖller＇ s muscles resection surgery. Follow-up period was 6 months. Results The effective rates were 76.7% and 92.2% in group A and group B re- spectively. The effective rate of group B was higher than group A singnificantly （P 〈 0.05 ）. The dissatisfac- tory rates were 23.3% （17 eyes） in group A and 7.7% （7 eyes） in group B. The dissatisfactory rate of group B was lower than group A significantly （ P 〈 0.05 ）. Postoperative complications in group A were over- correction in 5 eyes （6.8%）, wider space between the crease and the eyelash in 8 eyes （ 10.9% ）, over- correction and wider space between the crease and the eyelash in 4 eyes （5.4%）. No undercorrection was noticed in group A. Postoperative complications in group B were undercorrection in 4 eyes （4.4%）, higher outer position and lower inner position of upper eyelid in 2 eyes （2.2%）, wider space between the crease and the eyelash in 1 eyes （ 1.1% ）. Conclusion Either levator-Mǖller＇ s muscles lengthening or levator- Mǖiler＇ s muscles resection surgery was effective in the management of moderate or severe upper eyelid retraction of thyroid-associated ophthalmopathy. The levator-Mǖller＇ s muscles resection surgery is better than the lengthenning procedure.