结膜上穹窿联合筋膜鞘悬吊术治疗重度上睑下垂的临床疗效

Clinical efficacy of conjoint fascial sheath of the levator and superior rectus attached to conjunctival for- nix suspension surgery in treatment of severe blepharoptosis

目的探讨应用结膜上穹窿联合筋膜鞘（CFS）悬吊术和单切口额肌筋膜瓣悬吊术治疗重度上睑下垂的临床疗效。方法将21例患者分为两组，CFS悬吊组11例15只眼，额肌筋膜瓣悬吊组10例12只眼，术后随访1周至6个月，对两组患者术后效果进行比对，并进行统计学分析。结果改良单切口额肌筋膜瓣悬吊组2例术后眼睑闭合不佳，1例上睑形态不佳，4例上睑迟滞，2例复发，CFS悬吊术组1例出现欠矫现象，其余患者睑裂均能完全闭合，重睑外形良好，未见暴露性角膜炎。术后6个月疗效观察，CFS悬吊组并发症少，眼睑对称度占优，术后6个月下垂矫正效果及上睑回缩量均优于额肌筋膜瓣悬吊组，两组比较差异有统计学意义（P〈0．05）。结论CFS悬吊术治疗重度上睑下垂的方法具有美观、安全性高、外观自然、患者满意度高、并发症少、更加符合生理等优点，值得临床借鉴。

Objective To investigate the clinical efficacy of conjoint fascial sheath （CFS） of the levator and superior rectus attached to the conjunctival fornix suspension surgery and the modified frontails muscle suspension in the treatment of severe blepharoptosis. Methods There were 15 eyes of 11 patients in the group with CFS suspension and 12 eyes of 10 patients in the other group with fron- tails muscle suspension. Follow-up was conducted for 1 week to 6 months. The surgical results were compared with statistical analysis. Results Among the patients 2 cases of palpebral fissure was closed poorly, 1 cases of upper eyelid had poor shape, 4 cases of upper lid was lag, 2 cases of recurrence in group with modified frontails muscle suspension, and compared with 1 case of less straightening phe- nomenon in the group with CFS suspension. All the others, palpebral fissures were completely closed, the appearance of double eyelid was good, with no exposure keratitis. In terms of postoperative cura- tive effect in 6 months observation, group with CFS suspension had less complications and was of ad- vantages in the symmetry of upper eyelid fissure. The effect of correction post operation and upper eyelid back amount in the group with CFS suspension were better than those with the frontails muscle suspension in 6 months. There was significantly statistical difference. Conclusions The surgery with CFS suspension is of advantages of aesthetic appearance, high security, natural look, high satisfaction from patients, less complications and more in line with the physiology, which is worthy of clinical ref- erence.