明显不对称单睑睑裂的分型及矫正方法

Classification and corrective methods of obviously asymmetric palpebral fissure of single-fold eyelid

目的探讨明显不对称单睑睑裂的分型以及在重睑成形术中行同期矫正的方法。方法2010年1月-2014年9月，山东省临沂市人民医院收治40例双眼单睑睑裂明显不对称的重睑求术者，术前自然状态下双眼睑裂宽度相差1．0～2．0（1．44±0．23）mm。笔者根据患者双眼睑部特点，将明显不对称单睑睑裂分为3种类型，行全切法重睑成形术的同时进行如下矫正。（1）对24例单纯上睑皮肤松垂不等型者，采用去除睑缘松垂皮肤的方法矫正，双眼睑去除皮肤最宽处的宽度为各自睑缘皮肤松垂量的2倍（下同）。（2）对单纯睑裂宽度不等型中4例双眼睑裂宽度相差小于或等于1．4mm者，采用差量去皮法矫正，睑裂较窄一侧去除皮肤最宽处的宽度为双眼睑裂差值加1mm（下同）；另2例双眼睑裂宽度相差大于1．4mm者，采用差量去皮加缩短上睑提肌腱膜的方法矫正，睑裂较窄一侧缩短提肌腱膜宽度为双眼睑裂宽度差值加1mm（下同）。（3）10例伴上睑皮肤松垂且抚平松垂皮肤后双眼睑裂宽度相差大于1．0mm的混合型者，抚平松垂皮肤后，其中7例双眼睑裂宽度相差小于或等于1．4mm者，采用去除松垂皮肤和差量去皮法矫正；3例双眼睑裂宽度相差大于1．4mm者，采用去除松垂皮肤和差量去皮加缩短上睑提肌腱膜的方法矫正。随访时测量双眼睑裂宽度并计算差值，记录末次差值，对数据行配对样本t检验。结果术后9例患者出现去皮侧或联合缩短上睑提肌腱膜侧睑裂不能完全闭合情况，予以红霉素眼膏点眼治疗，未出现结膜炎或角膜炎等并发症，于术后1周～1个月闭合。随访8～12个月，所有患者重睑形态自然，线条流畅，双眼睑裂无明显不对称，不对称睑裂未见复发。末次随访时双眼睑裂宽度相差0．1～0．5（0．19±0．09）mm，与术前比较，差值明显缩小（t=39．202，P〈0．001）。结论重睑成形术中可对明显不对称单睑睑裂进行矫正，其中单纯上睑皮肤松垂不等型采用去除睑缘松垂皮肤的方法矫正；单纯睑裂宽度不等型采用差量去皮或联合缩短上睑提肌腱膜的方法矫正；合并前述2种情况的混合型在去除睑缘松垂皮肤的同时，采用差量去皮或联合缩短上睑提肌腱膜的方法矫正。

Objective To discuss the classification of obviously asymmetric palpebral fissure of single-fold eyelid and their corrective methods performed with double-fold eyelid blepharop]asty simultaneously. Methods Forty patients with obviously asymmetric palpebral fissure of single-fold eyelid of two eyes were admitted to Linyi People＇s Hospital in Shandong province from January 2010 to September 2014, asking for double-fold eyelid blepharoplasty. The preoperative difference of palpebral fissure width between two eyes reached 1.0 - 2.0 （ 1.44± 0.23 ） ram. Obviously asymmetric palpebral fissures of single-fold eyelid were divided into three types according to the characteristics of eyelids of two eyes and were corrected by following methods performed with double-fold eyelid blepharoplasty with total incision simultaneously. （ 1 ） Twentyfour patients only with different sagging skin of upper eyelids were corrected by resecting sagging skin of eye- lids＇ margins, and the width of the widest position of reseeted eyelids＇ skin was twice as wide as that of the sagging skin of eyelids＇ margins （ the same below）. （2） Among 6 patients only with different palpebral fissure width, 4 patients whose difference of palpebral fissure width was not bigger than 1.4 mm were corrected by the method of resecting surplus skin, and the width of the widest position of resected eyelids＇ skin with narrower palpebral fissure was 1 mm wider than the difference of palpebral fissure width between two eyes （the same below）. The other 2 patients whose difference of palpebral fissure width between two eyes was bigger than 1.4 mm were corrected by the method of resecting surplus skin and shortening aponeurosis of levator muscle of upper eyelid. The width of shortened aponeurosis of levator muscle of eyelids with narrower palpebral fissure was 1 mm wider than difference of palpebral fissure width between two eyes （the same below）. （3） Among 10 patients with mixing symptoms of sagging upper eyelids skin and difference of palpebral fissure width bigger than 1.0 mm after smoothing sagging upper eyelids＇ skin, 7 patients whose difference of palpebral fissure width was not bigger than 1.4 mm were corrected by resecting sagging skin and the method of resecting surplus skin. The other 3 patients whose difference of palpebral fissure width was bigger than 1.4 mm were corrected by resecting sagging skin, shortening aponeurosis of levator muscle of upper eyelids and resecting surplus skin. Palpebral fissure widths of patients were measured during follow-up. Difference of palpebral fissure width between two eyes was calculated and the last difference was recorded. Data were processed with paired sample t test. Results Nine patients who showed incomplete closure of palpebral fissure on the sides of resected eyelids skin or shortened aponeurosis of levator muscle of upper eyelids after operations were treated with erythromycin eye ointment drop in eyes and recovered one week to one month after operations, with no complication of conjunctivitis or keratitis. Double-fold eyelids of all patients who were followed up for 8 to 12 months showed natural shape, smooth lines. No patient showed obvious asymmetry of palpebral fissure between two eyes, and no recurrence of asymmetric palpebral fissure was ob- served. Difference of palpebral fissure width was 0.1 - 0.5 （0.19±0.09） mm in the last follow-up, which was obviously smaller than that before operation （ t = 39. 202, P 〈 0. 001 ）. Conclusions Obviously asymmetric palpebral fissure of single-fold eyelid can be corrected during the operation of double-fold eyelid blepharoplasty. Patients only with different sagging skin of upper eyelids can be corrected by resecting sag- ging skin of eyelids＇ margins. Patients only with different palpebral fissure width between two eyes can be corrected by the method of resecting surplus skin or combining the method of shortening aponeurosis of levator muscle of upper eyelids. Patients with different sagging skin of upper eyelids and different palpebral fissure width can be corrected by resecting sagging skin of eyelids＇ margins and the method of resecting surplus skin or combining the method of shortening aponeurosis of levator muscle of upper eyelids.