严重上睑内翻睑缘切开带蒂眼轮匝肌瓣充填术的设计

Palpebral margin incision and pediculated orbicular muscle grafting for the treatment upper eyelid entropion

目的评价治疗严重上睑内翻的手术设计的临床疗效。方法2005年1月至2013年12月我院眼科门诊严重上睑内翻2974例（3314只眼），包含有曾行一次或多次睑内翻倒睫矫正手术后复发者48例（56眼）。男1349例（1392眼），年龄47～87岁，平均（64．50±2．00）岁。女1625例（1922眼），年龄43～86岁，平均（61．50±1．50）岁。均进行新设计的睑缘灰线切开带蒂轮匝肌瓣充填术。术后于1周、3个月、12个月及24个月进行观察。结果术后1周无复发病例，失访11例（12眼）。术后3个月倒睫局部复发14例（15眼），复发率为0．46％，失访37例（40眼）。术后12个月倒睫局部复发23例（25眼），复发率为0．75％，失访56例（61眼）。术后24个月倒睫局部复发23例（25眼），复发率为0．82％。失访233例（276眼）。至末次随访时，共失访337例（389眼），共复发60例（65眼），复发率为2．22％。均无并发症发生。术后视力较术前有提高者1927例（1956眼），占末次随访时术眼总数的66．87％；视力无明显变化者710例（969眼），占末次随访时术眼总数的33．12％；术后视力较术前无下降者。结论睑缘切开带蒂轮匝肌瓣充填术治疗严重上睑内翻的近期及远期疗效较好，复发率低，是一种有效的上睑内翻矫正手术。

Objective To evaluate the clinical efficacy of the design of surgical method for the treatment of severe upper eyelid entropion. Methods Total of 3314 eyes of 2974 cases with severe upper eyelid entropion from January 2005 to December 2013 were treated with the method of palpebralis margin incision and pediculated orbicular muscle grafting in our hospital. Among the cases, there were male 1392 eyes of 1349 cases, aging from 47 to 87, the average age was （64.50 ＋2.00） years;and 1922 eyes of 1625 cases are female, aging from 43 to 86, the average age was （61.50 ＋- 1.50） years. There were 56 eyes of 48 patients who recurred after one or more times surgeries of upper eyelid entropion rectification. The therapeutic effect was observed at 1 week, 3 months, 12 months and 24 months after surgery. Results There were no recurred ease at postoperative 1 week and 12 eyes of 11 cases lost to follow-up. At 3 months postoperatively, 15 eyes of 14 cases recurred, the recurrence rate was O. 46% , 40 eyes of 37 cases lost to follow-up. At 12 months postoperatively, 25 eyes of 23 cases recurred, the recurrence rate was 0.75 % , 61 eyes of 56 cases lust to follow-up. At 24 months postoperatively, 25 eyes of 23 cases recurred, 276 eyes of 233 cases lost to follow-up, the recurrence rate was 0.82%. The total number was 389 eyes of 337 cases lost to follow-up and 65 eyes of 60 cases recurred, the recurrence rate was 2.22%. No complication happened. The visual acuities were improved in 1956 eyes of 1927 cases postoperatively, accounting for 66.87 %. The vision had no obvious change in 969 eyes of 710 eases, accounting for 3.3. 12%. No ease appeared decreased vision. Conclusion The surgery of palpebralis margin incision and pedieulated orbicular musele grafting is safe and effective for the treatment of severe upper eyelid entropion with low recurrence rate.