46例Ⅱ、Ⅲ度瘢痕性睑外翻手术治疗的临床分析

Clinical effect of surgical reconstruction of Ⅱ and Ⅲ degree cicatricial ectropion in 46 patients

目的探讨瘢痕性睑外翻的手术细节的改进及治疗效果。方法回顾我科收治的Ⅱ、Ⅲ度瘢痕性睑外翻患者46例,根据睑外翻的程度和局部情况,选择眼睑部正常皮肤与瘢痕组织交界处设计切口线,尽可能保留和恢复眼轮匝肌结构,松解区域分别超出内外眦处并达眼裂水平,采用全厚皮片游离移植术行睑外翻手术矫正并行睑缘融合,皮片于内外眦韧带处行皮内固定。结果随访6个月至2年,46例眼睑皮片完全存活,眼睑复位良好,无1例眼睑闭合不全。结论适当的选择手术切口线及松解范围,尽可能保留眼轮匝肌的结构完整并对移植皮片在内外眦处进行固定,可以有效预防睑外翻的复发,提升手术效果。

Objective To improve the detail of the surgery for cicatricial ectropion,and the the effect was investigated. Methods Based on 46 patients withⅡ,Ⅲdegree cicatricial ectropion admitted to our department,choose the junction of normal skin and scar tissue as the incision line according to the degree of ectropion and local situation,and to reserve and recover the orbicularis oculi muscle as possible. The released areas exceeded separately the external canthus and reached the level of eye fissure,take advantage of full-thickness skin graft to correct the parallel lines and make fixation to the eyelid ectropion fusion skin graft on external canthal ligament. Results After followed up for 6 months to 2 years,46 cases of eyelid skin grafts survived completely and eyelids were in good reduction,with none case of incomplete eyelid closure. Conclusion Choose the surgical incision and the released areas in a proper way to reserve the structural integrity of orbicu-laris muscle and make skin graft fixation to inner and external canthal skin can prevent effectively the recurrence of ectropion and improve surgical progress.