泪腺窝微骨孔固定泪腺治疗泪腺脱垂临床探讨

The clinical study of suspension of prolapsed lacrimal glands via keyhole of lacrimal fossa

目的探讨采用眶骨造孔法将泪腺经泪腺窝微骨孔原位固定治疗泪腺脱垂的临床疗效。方法回顾性分析24例48只眼泪腺脱垂患者，经重睑皮肤切口，采用颞上方眶骨缘造孔法，将泪腺组织经微骨孔固定于泪腺窝，分析影像学及眼部外观改变，评价泪腺的复位情况，分析术前术后泪液分泌试验、泪膜破裂时间，观察泪腺功能的改变。术后随访6～24个月（平均12个月）。结果术后影像学显示所有24例48只眼的泪腺解剖复位率100％，随访期间均无泪腺脱垂复发，上睑外侧臃肿消失，重睑形成良好，眼部外观满意。术前术后Schirmer试验、泪膜破裂时间（BUT）差异无统计学意义（P〉0．05），所有24例48只眼均无干眼症状。结论经重睑皮肤切口行泪腺窝眶骨造孔固定泪腺治疗泪腺脱垂，泪腺解剖复位良好，不易复发，重睑形成自然，对泪腺功能损伤小，值得临床推广。

Objective To evaluate the effect of suspension of the prolapsed lacrimal glands via keyhole of lacrimal fossa. Methods Twenty four patients （48 eyes） with prolapsed lacrimal glands were studied for retrospective analysis. The operation was done via double eyelid incision approach. Two keyholes were performed behind superolateral orbital rim. The lacrimal glands were suspended into the lacrimal fossa through the 2 keyholes with 3-0 suture. The appearance of the patients and CT features were analyzed after operation. The Schirmer＇s test and break up time （BUT） test were done before and after operation in all the patients. The postoperative follow up periods ranged from 6 to 24 months （mean=12 months）. Results The lacrimal glands of 24 patients （48 eyes） were repo-sitioned perfectly. No recurrence occurred during the follow up periods. The striking bulkiness of temporal upper eyelid disappeared, upper eyelid arc was moderate, and the appearance was satisfy-ing. The results of Schirmer＇s test and BUT test were normal after operation. No one suffered the dry eye syndrome and foreign body sensation after operation. Conclusions Suspension the lacrimal glands into lacrimal fossa through the pores of superolateral orbital rim is a good method to treat lacrimal glands prolapse, it can achieve functional and cosmetically acceptable results, and may have wide application prospects in future.