微创上睑下垂矫正术应用体会

Application experience of minimally invasive surgery on correction ptosis

目的：评估微创矫正上睑下垂术的临床效果，分析失败原因，探讨提高手术成功率的要点。方法：选择患者满意的重睑高度并画线，在线上标志2～4个点。局麻满意后，切开标记点皮肤不超过1mm。于结膜面的睑板上缘预置牵引线。用3-0双针尼龙线2～4根，每根线的两端先后从上穹窿结膜的同一点进针，穿过结膜深部，穿行于上睑提肌和Muller肌至睑板上缘穿出，将上睑提肌腱膜和Muller肌收紧。线两端再从睑板上缘的出针点穿过结膜及睑板从皮肤面的切口处穿出，拉紧打结，线结埋于皮下，上睑下垂得以矫正，外观无明显伤口及线结。结果：接受微创上睑下垂矫正术并且术后随访6个月以上者共有21例。完全矫正10只眼，下垂改善13只眼，无效2只眼。有效率92%，满意率40%。结论：微创上睑下垂矫正术虽然有其优点，但效果不能持久，易复发。总结原因发现，注意使收紧线穿行于肌肉深浅不同的层面、选择合适的缝线、增加悬吊线的数量，可以明显提高成功率。

Objective To assess the clinical effect of minimally invasive correction of ptosis. Analysis of the causes of failure.To find the methods of improvement the success rate of operation. Methods Mark 2-4 points on upper lid fold.Afrer anesthesia,cutting the skin in markers.To preset the tractive line at tarsus margin.After turning the upper eyelid inside out,thread is introduced into it through the conjunctiva close to the superior fornix.Then the superior palpebral levator muscle and the tarsus are connected using threads. Two ends of the thread through out from the upper edge of the skin. This thread application is performed at 2-4 locations of the upper eyelid. By tightening the threads,the tarsus was elevated and the ptosis eyelid is corrected. Results 21 patients were operated on with this surgical method.The complete correction of ptosis was achieved with 10 eyes,and improvement was achieved with 13 eyes.The completely ineffective was in 2 eyes during 6 months followed-up.The effective rate is 92%.The satisfaction rate of 40%. Conclusions lthough this operation is minimally invasive,but can not keep the result for long time. Tightening up the thread through the muscle in different levels,using more suitable and quantity thread may be able to meet the success.