三种术式联合一期修复合并内眦赘皮的上睑睑黄瘤术后缺损

COMBINED THREE OPERATIONS FOR ONE STAGE DEFECTS REPAIR AFTER RESECTION OF LARGE XANTHELASMA PALPEBRARUM WITH EPICANTHUS

目的探讨联合全上睑旋转皮瓣、重睑成形术及＂Z＂成形内眦赘皮矫正术一期修复合并内眦赘皮的较大上睑睑黄瘤切除术后缺损。方法 2013年12月-2015年12月,收治12例合并内眦赘皮的较大上睑睑黄瘤女性患者。患者年龄36~59岁,平均43岁。病程3~16年,平均11年。首次切除6例,二次切除残余睑黄瘤4例,切除术后复发2例。睑黄瘤最大横径为0.5~1.3 cm,平均1.0 cm;为边界不规则斑块,呈深黄色。内眦赘皮根据车俊敏等提出的分度标准：轻度7例,中度3例,重度2例。患者血脂检查均在正常范围。术中切除睑黄瘤后,联合全上睑旋转皮瓣、重睑成形术及＂Z＂成形内眦赘皮矫正术修复缺损。结果术后切口均Ⅰ期愈合,皮瓣顺利成活,无手术相关并发症发生。术后1个月复查见4例瘢痕增生明显,行瘢痕综合治疗。患者均获随访,随访时间3个月~2年,平均1.5年。重睑效果良好,睑黄瘤无复发。结论联合全上睑旋转皮瓣、重睑成形术及＂Z＂成形内眦赘皮矫正术修复合并内眦赘皮的上睑睑黄瘤切除后较大缺损,可以有效缓解皮瓣尖端内眦部张力,在修复缺损同时获得良好的重睑和内眦形态。

Objective To investigate the effectiveness of combined three operations（rotated total upper eyelid skin flap, construction of double eyelid, and ＂Z＂ flap epicanthal plasty） for one stage defect repair after resection of xanthelasma palpebrarum with epicanthus. Methods Between December 2013 and December 2015, 12 female patients with large xanthelasma palpebrarum and epicanthus underwent rotated total upper eyelid skin flap, construction of double eyelid, and ＂Z＂ flap epicanthal plasty for one stage defect repair. The age ranged from 36 to 59 years（mean, 43 years）. The course of disease was 3 to 16 years, with an average of 11 years. The initial resection was performed in 6 cases, second resection of residual xanthelasma palpebrarum in 4 cases, and 2 cases had recurrence after resection. The maximum diameter of xanthelasma palpebrarum was 0.5-1.3 cm（mean, 1.0 cm）. According to CHE Junmin et al criterion, epicanthus was rated as mild in 7 cases, moderate in 3 cases, and severe in 2 cases. The blood lipid level was in normal range. Results Primary healing of incision was obtained, and the flaps survived in all patients; no complication occurred. Scar hyperplasia was found in 4 cases at 1 month after operation, and the comprehensive treatment of scar was performed. All patients were followed up for 3 months to 2 years, with an average of 1.5 years. Double eyelid effects were good, and no xanthelasma palpebrarum recurred. Conclusion A combination of rotated total upper eyelid skin flap, construction of double eyelid, and ＂Z＂ flap epicanthal plasty is an effective operative procedure to repair defect after resection of xanthelasma palpebrarum with epicanthus; and better curve of double eyelid, better shape of endocanthion, and less tension of flap can be got.