皮肤眼轮匝肌切除联合睫毛外翻褥式缝合矫正儿童下睑倒睫的疗效观察

Curative effect of the skin and orbicularis muscle resection combined with valgus eyelash mattress suture on children lower eyelid trichiasis

目的观察下睑皮肤眼轮匝肌切除联合睫毛外翻褥式缝合矫正术治疗儿童下睑倒睫的远期疗效。设计回顾性病例系列。研究对象2013年6月至2016年2月北京同仁医院眼科下睑倒睫患儿200例(400眼),年龄3~10岁,平均5.56±2.30岁。方法对200例(400眼)下睑倒睫者适量切除下睑皮肤及眼轮匝肌,睫毛外翻褥式缝合,皮肤连续缝合,部分患者联合灰线切开。术后随访观察6~12个月。主要指标睫毛位置、畏光、流泪、角膜损伤、眼睑位置形态、有无下睑泪小点外翻、下睑皮肤凹陷性瘢痕、有无明显的下双眼皮。结果术后患者倒睫全部矫正。200例患者术后随访观察6个月,倒睫无复发。170例患儿随访观察12个月,1例(1眼)倒睫部分复发。术后200例患儿畏光、流泪均消失,200例(380眼)角膜上皮损伤愈合,无下睑内、外翻,无下睑泪小点外翻,无下睑切口处皮肤凹陷性瘢痕,无明显下双眼皮,外观良好。结论通过对下睑倒睫手术方案的精准设计,皮肤以及眼轮匝肌切除联合睫毛外翻褥式缝合,远期观察倒睫手术效果确切,且外观恢复良好。

Objective To observe the curative effect of part of the skin and orbicularis muscle resection combined with eyelash valgus mattress suture on the children with lower eyelid trichiasis. Design Retrospective case series. Partcipants 200 cases （400 eyes） with lower eyelid trichiasis in Beijing Tongren Eye Center from June 2013 to February 2016, 3-10 years old, with an average age of 5.56±2.30 years. Methods Application of lower eyelid skin and orbicularis resection amount, eyelash valgus mattress suture, skin continuous suture, some patients with gray line incision, 400 eyes of 200 cases in the treatment of lower eyelid trichiasis. All patients were followed up for a period of 6 to 12 months. Main Outcome Measures Eyelash position, photophobia, tear, corneal epithelium damage, position and morphology of the eyelid, with or without lacrimal point valgus, lower eyelid depressed scar, with or without lower double eyelid. Results All patients with postoperative correction of trichiasis, 200 cases of patients with postoperative follow-up of 6 months, no recurrent trichiasis. 170 patients were followed for 12 months, and 1 case was recurrence. After surgery, the patient’s photophobia and tears disappear. Corneal epithelium healing, no entropion and ectropion, no skin depressed scar, no obvious lower double eyelid, good appearance. Conclusion The low eyelid trichiasis surgery program, putting off skin amount, incisioning accurate design, eyelash valgus mattress suturing, skin continuous suturing, and the application of gray line incision, not only make the lower eyelid trichiasis corrected, but also let the children have good appearance.