重睑成形术后上睑缘外翻及重睑线凹陷过深的不良形态分析与修复效果

Bad eye state and its repair of ectropion and heavy eyelid line sag after blepharoplasty

目的 探讨重睑成形术后上睑缘外翻及重睑线凹陷过深2项不良形态的修复效果以及其成因与预防.方法 对重睑成形术后上睑不良形态分型与分级,并手术修复.将上睑由内眦至外眦均分为Ⅰ、Ⅱ、Ⅲ区.（1）针对上睑缘外翻畸形者测量三区睫毛根部提升角（lift-up angle,LA）,平视位、上视位中央区睑缘露白相对面积（relative area of exposed central eyelid margin,RA）.（2）对重睑线凹陷过深者测量三区重睑线处凹陷相对深度（relative depth of double eyelid fold,RD）.结果 （1）上睑缘外翻畸形18只眼,修复术前与术后6个月分级差异有统计学意义（P＜0.05）;Ⅱ区LA由（95.11±9.66）°降至（79.50±6.71）°（P＜0.05）,Ⅰ、Ⅲ区差异无统计学意义（P＞0.05）;平视位RA由（4.22±0.66）×10-2降至（0.23±0.22）×10^-2 （P＜0.05）;上视位RA由（4.51±0.65）×10-2降至（0.59±0.21）×10^-2 （P＜0.05）.（2）重睑线凹陷过深畸形24只眼,修复术前与术后6个月分级差异有统计学意义（P＜0.05）;Ⅰ区RD由（7.14±0.89）×10-2降至（1.70±0.61）×10^-2 （P＜0.05）,Ⅱ区RD由（8.90±0.90）×10^-2降至（2.28±0.63）×10^-2 （P＜0.05）,Ⅲ区差异无统计学意义（P＞0.05）.结论 重睑成形术后的不良形态值得临床重视,合理设计手术矫正可有效改善外观,并减轻不适感.

Objective To discuss the unsatisfied appearance of upper eyelid after double eyelid blepharoplasty,and to present its therapeutic schedule,curative effects,pathogenesis and precautions.Methods All eyes were classified into two types and repaired.Each upper eyelid was horizontally and equally divided into three sections named as Ⅰ,Ⅱ,and Ⅲ from inner to outer canthus.The lift-up angles （LA） of the 3 sections,the relative areas of exposed central eyelid margin （RA） of headup position and looking-up were measured on the upper eyelid margin ectropion of eyes.The relative depth of double-eyelid fold （RD） of 3 sections were measured on the double-eyelid fold depression of eyes.Results Six months after the repair,the grades of both types were significantly different from the grades before （P〈0.01）.Concerning 18 upper eyelid margin ectropion eyes,LA in section Ⅱ changed from （95.11±9.66）° to （79.50≈6.71）° （P〈0.05） while there were no significant change in sections Ⅰ and Ⅲ （P〉0.05）,and the RA of head-up position changed from （4.22±0.66） × 10-2 to （0.23± 0.22） × 10-2 while the RA of looking-up changed from （4.51 ± 0.65） × 10-2 to （0.59 ±0.21） × 10-2 （p〈 0.05）.Concerning 24 double-eyelid fold depression eyes,the RD in section Ⅰchanged from （7.14±0.89） × 10-2 to （1.70±0.61） × 10-2 and the RD in section Ⅱ changed from （8.90±0.90） × 10-2 to （2.28±0.63） × 10-2 （P〈0.05）,while there were no significant change in section Ⅲ （P〉0.05）.Conclusions Unsatisfied appearance after double eyelid blepharoplasty must be paid highly attention in clinical setting,and the appearance and symptoms can be effectively improved by using proper surgical procedures.