经重睑切口的上睑旋转皮瓣矫正轻中度内眦赘皮疗效观察

Effectiveness of upper eyelid rotation flap via blepharoplasty incision for correction of mild to moderate epicanthus

目的探讨重睑术中采用经重睑切口的上睑旋转皮瓣矫正轻、中度内眦赘皮的疗效。方法回顾分析2016年7月—2017年10月,重睑术中采用经重睑切口的上睑旋转皮瓣矫正轻、中度睑板型内眦赘皮合并单睑的34例患者(试验组)临床资料;以同期38例接受传统"Z"成形内眦开大术联合重睑术患者为对照(对照组)。两组患者年龄及内侧赘皮分度比较,差异无统计学意义(P>0.05)。于术前及术后6 d、6个月测量眼裂长度,计算眼裂长度改善程度;参照内眦赘皮矫正标准评价手术疗效。结果两组患者切口均Ⅰ期愈合,并获随访6个月。两组内眦赘皮明显矫正。试验组内眦处无切口;对照组遗留瘢痕,其中6例增生明显。术后6 d试验组及对照组眼裂长度改善程度分别为3.63%±0.07%、3.70%±0.05%;术后6个月分别为4.64%±0.09%、4.46%±0.10%;两组比较差异均无统计学意义(t=0.005,P=0.996;t=0.287,P=0.871)。术后6个月疗效评价,试验组优20例、良12例、差2例,优良率94.12%;对照组优16例、良16例、差6例,优良率84.21%;差异无统计学意义(χ~2=0.796,P=0.372)。结论经重睑切口的上睑旋转皮瓣矫正轻、中度内眦赘皮手术操作简便、效果满意,内眦处无瘢痕形成。

Objective To evaluate an modified epicanthoplasty which can reduce epicanthic scar in blepharoplasty with mild to moderate epicanthus, by using upper eyelid rotation flap via blepharoplasty incision. Methods A clinical data of 34 patients with mild and moderate epicanthus(trial group), who were treated with blepharoplasty and epicanthoplasty by using upper eyelid rotation flap, between July 2016 and October 2017, was retrospectively analyzed.And 38 patients who were treated with blepharoplasty and epicanthoplasty by using traditional "Z" plastic method were recruited as control group. There was no significant difference in age and degree of epicanthus between 2 groups(P>0.05).The lengths of palpebral fissure were measured at preoperation and at 6 days and 6 months after operation, and the length difference between pre-and post-operation was calculated to evaluate the improvement degree. The effectiveness was evaluated with reference to the scale of epicanthus orthopedics. Results All incisions of 2 groups healed by first intention, and all patients were followed up 6 months. The epicanthi of 2 groups were significantly corrected. The inner canthus of trial group had no incision;and there were scars at inner canthus of control group, with obvious hyperplasia in6 cases. The improvement degree of the length of palpebral fissure in trial group and control group were 3.63%±0.07%,3.70%±0.05% and 4.64%±0.09%, 4.46%±0.10% at 6 days and 6 months after operation, respectively. There was no significant difference between 2 groups(t=0.005, P=0.996;t=0.287, P=0.871). The effectiveness was excellent in 20 cases,good in 12 cases, and poor in 2 cases in trial group, with an excellent and good rate of 94.12%;meanwhile, the effectiveness was excellent in 16 cases, good in 16 cases, and poor in 6 cases in control group, with an excellent and good rate of 84.21%.T here was no significant difference between 2 groups(χ^2=0.796, P=0.372). Conclusion The modified epicanthoplasty byusing upper eyelid rotation flap via blepharoplasty incision can significantly reduce epicanthic scar with simple operation and satisfactory effectiveness.