A型肉毒素注射与眶周全肌切除术治疗特发性眼睑痉挛的比较

Comparison of effects of botulinus toxin of type A and complete resection of the periorbital muscle for idiopathic blepharospasm

目的:比较A型肉毒素注射与眶周全肌切除术治疗特发性眼睑痉挛的疗效。方法:前瞻性非随机对照试验。选取2010-12/2015-06间在我院实施A型肉毒素注射治疗的特发性眼睑痉挛患者30例60眼,同时选取年龄匹配的眶周全肌切除术治疗的特发性眼睑痉挛患者30例60眼,随访观察6mo,比较两组的疗效和复发率。结果:A型肉毒素注射治疗组完全缓解、明显缓解、部分缓解和无效的眼数分别为36眼(60.0%),20眼(33.3%)、2眼(3.3%)和2眼(3.3%)。眶周全肌切除术治疗组为16眼(26.7%),24眼(40.0%)、12眼(20.0%)和8眼(13.3%),两组比较差异有统计学意义(Z=-2.968,P=0.003)。治疗6mo后两组的复发率为93.3%和20.0%,比较差异有统计学意义(χ2=32.851,P<0.001)。结论:A型肉毒素注射治疗对于特发性眼睑痉挛疗效好,但6mo后容易复发。眶周全肌切除术疗效确定且长期疗效稳定,可作为A型肉毒素注射治疗后复发的有效治疗途径。

AIM： To compare the effectiveness of botulinus toxin of type A and complete resection of the periorbital muscle on idiopathic blepharospasm. ● METHODS： Patients with idiopathic blepharospasm and having undergone either of two procedures from Dec. 2010 to Jun. 2015 were selected （ 60 patients ） . Among them, group A （30 patients, 60 eyes） underwent botulinus toxin of type A, group B （30 patients, 60 eyes） underwent complete resection of the periorbital muscle. ●RESULTS： ln group A, the patients with complete response, obvious response, partial response, and no response were 36（60. 0%）, 20（33. 3%）, 2（3. 3%） and 2 （3. 3%） cases respectively. ln group B, the patients with complete response, obvious response, partial response, and no response were 16（26. 7%）, 24（40. 0）, 12（20. 0%） and 8 （ 13. 3%） cases respectively. The difference was statistically significant （ Z = - 2. 968, P = 0. 003 ）. The relapse rate of group A and group B were 93. 3% and 20. 0% after 6mo, the difference was statistically significant （χ2=32. 851, P〈0. 001）. ●CONCLUSION： The botulinus toxin injection of type A is effective for idiopathic blepharospasm. But recurrence rate is high after 6mo. Complete resection of the periorbital muscle have long-term efficacy for idiopathic blepharospasm. It′s a supplementary therapy after idiopathic blepharospasm recurrence.