先天性下睑内翻合并眼睑退缩的手术探讨

An investigation of the surgery for the treatment of congenital entropion combined with lower lid retraction

目的探讨先天性睑内翻同时存在眼睑退缩的手术治疗方式。方法先天性下睑内翻合并眼睑退缩35例（70眼）进行内路下睑缩肌切除联合缝线法矫正手术。经结膜入路，完全暴露下睑缩肌前表面，沿睑板下缘分离下睑缩肌，将下睑缩肌完全分离至下穹隆，于穹隆水平切断并部分切除。缝合结膜切口后行缝线法，即2号丝线双针经距睑缘2mm皮肤进针、穹隆部结膜出针，再反转回皮肤睑缘下，做3对褥式缝线，术后随访5—7个月，测量下睑位置，观察手术效果。以下睑位于角膜下缘之上0．5mm且睫毛不向内翻转为治愈。结果35例（70眼）符合纳入标准，随访期末，33例（66眼）睑内翻矫正良好，2例（4眼）睑内翻矫正不足，治愈率94．29％。复发2例，二次手术行L型皮肤切除联合下睑部分轮匝肌切除，术后效果良好。无过矫、外翻或眼睑角状畸形者。结论内路下睑缩肌切除联合缝线法治疗先天性下睑内翻合并睑退缩可获得较好的疗效。

Objective To investigate the effect of surgical treatment on congenital entropion combined with lower lid retraction. Methods Seventy eyes of 35 cases of congenital entropion combined with lower lid retraction underwent the surgical treatment of retractor myectomy combined with rotational suture. During the surgery, the lowerlid retraction muscle was cut off along with inferior border of lower tarsus, and the conjunctiva was sutured with 6 -0 polyglycolic sutures, for the rotational suture procedure, after marking the normal position of the eyelid crease, one needle of a double-armed 2 - 0 nylon sutures was inserted through skin 2 mm away from the inferior border of the tarsus and withdrawed from the conjunctiva and then reversed to skin in the previously marked eyelid crease to make three pair of mattress-suture. The follow-up was 5 to 7 months. The position of lower lid margin was measured and the effect after surgery was observed. The cure criterion was that the lower lid margin was located 0.5 mm above inferior corneal limbus and no trichiasis occurred. Results After the operation, among 70 eyes the position of lower lid was normal in 66 eyes. Another 4 eyes received reoperation. Conclusion Myectomy of lower lid retractor combined with rotational suture is effective for congenital lowerlid entropion with lower lid retraction.