超常量提上睑肌缩短及额肌瓣悬吊治疗重度先天性上睑下垂效果比较

Efficacy comparison of severe congenital ptosis treated with excessive levator shortening and frontalis muxle flap suspension

目的:比较提上睑肌缩短术与额肌瓣悬吊术治疗重度先天性上睑下垂的疗效与并发症。方法:对40例58眼重度先天性上睑下垂患者进行手术治疗,其中,20例28眼行额肌腱膜瓣悬吊术,20例30眼行改良的提上睑肌缩短术,术后随访6mo,观察两种手术方式治疗重度先天性上睑下垂的治疗效果及术后并发症的发生情况。结果:术后随访6mo,提上睑肌缩短术组及额肌瓣悬吊术组治疗重度先天性上睑下垂的正矫率分别为:83%、82%,差异无统计学意义(P>0.05),但术后并发症的发生,如倒睫、闭合不全、暴露性角膜炎、结膜脱垂等,提上睑肌缩短术组少于额肌瓣悬吊术组,且有更好的外观。提上睑肌缩短术后6mo复诊时,眼睑闭合不全15眼,暴露性角膜炎共1眼,结膜脱垂2眼;额肌瓣悬吊术后6mo随诊,眼睑闭合不全23眼,暴露性角膜炎2眼,上睑倒睫3眼。结论:提上睑肌缩短术及额肌瓣悬吊术均能有效矫正重度先天性上睑下垂,但前者并发症少,术后外观好。

AIM：To compare the outcomes of severe congenital ptosis treated with levator shortening and frontalis muscle flap suspension.METHODS：Forty cases（58 eyes） with severe congenital ptosis were retrospective analyzed.Shortening levator muscle of upper eyelid was conducted in 30 eyes,and 28 eyes were treated with frontalis muscle flap suspension.All cases were followed up for 6mo.The ptosis correction rates were analyzed.Post- operative complications such as blepharelosis,hypophasis,exposure keratitis and conjunctival prolapse were recorded.RESULTS：There was no statistically significant difference in the complete correction rate between levator shortening group and frontalis muscle flap suspension group（83%vs 82%,P〈0.05）.However,the levator shortening had better appearance and fewer complications,such as blepharelosis（0 vs 3）,hypophasis（15 vs 23）,exposure keratitis（1 vs 2）,and conjunctival prolapse（2 vs 3） at 6mo after surgeries.CONCLUSION：Both the operations are effective on the treatment of severe congenital ptosis.However,levator shortening surgery leads to fewer complications and better appearance.