眶周肌肉切除术与A型肉毒毒素治疗特发性眼睑痉挛的选择与评估

Selection and evaluation of orbital muscle excision and botulinum toxin A in the treatment of blepharospasm

目的：探讨眶周肌肉切除术与A型肉毒毒素治疗眼睑痉挛的选择依据。方法：回顾性分析2012-03／2014-05来我科诊治的特发性眼睑痉挛患者100例，根据眼睑痉挛的程度将其分成0～Ⅳ级，按分级分为两组：A组为眼睑痉挛I～Ⅲ级患者60例，行A型肉毒毒素治疗；B组为眼睑痉挛〉Ⅲ～Ⅳ级患者40例，采用眶周肌肉切除术治疗。术后随访3-24mo。结果：A组60例患者行A型肉毒毒素注射后，57例患者眼睑痉挛分级为0级，完全矫正，2例注射后残留部分痉挛，但分级均明显下降，1例无效。B组40例患者中有25例患者行肉毒毒素治疗已耐受，属复发性并伴有眉下垂和上睑下垂症状，均改行眶周肌肉切除术，患者行眶周肌肉切除术后，30例患者痉挛分级为0级，7例为I级，3例为Ⅱ级。结论：根据眼睑痉挛的临床分级，正确选择特发性眼睑痉挛的治疗方法可提高治疗的有效性和安全性。

AIM： To investigate the choice basis of orbital muscle excision and botulinum toxin A injection in the treatment of blepharospasm. METHODS： This retrospective clinical analysis was involved 100 cases with idiopathic blepharospasm. According to the degree of blepharospasm, they were divided into 0-IV grade, and divided into two groups. Group A included 60 cases （Ⅰ-Ⅲ grade） treated with botulinum toxin A, and 40 cases （〉 Ⅲ-Ⅳ Vgrade） in group B treated with orbital muscle excision during the period from March 2012 to May 2014 in our hospital. Patients were followed up 3 - 24mo. RESULTS： In 60 cases of group A, After treatment, 57 patients were completely corrected with classified grade of 0, 2 patients residue spasm, but its grade was decreased significantly, and 1 case had no effect. Of 40 patients in group B were in grade 〉Ⅲ-Ⅳ, 25 patients were poor response to botulinum toxin treatment and accompanied with drooping eyebrow and eyelid ptosis symptoms. Thirty patients were completely corrected after injection, 7 residue cases were in grade Ⅰ , 3 cases in grade Ⅱ. CONCLUSION： The correct choice of the treatment for blepharospasm according to the clinical classification can improve the efficacy and safety.