联合筋膜鞘悬吊术治疗小儿中重度上睑下垂

The clinical analysis of conjoint fascial sheath suspension on the treatment of pediatric congenital moderate-severe ptosis

目的 探讨联合筋膜鞘悬吊术治疗中重度小儿先天性上睑下垂的功能和美容效果.方法 2013年12月至2014年12月,回顾性分析了44例（58只眼）先天性中重度上睑下垂患儿行CFS悬吊术的效果.对患儿手术前后上睑活动度（LF）、上睑缘中央到角膜反光点的距离（MRD）、重睑形状、外观和不良反应等指标给予记录和统计学处理,从功能、美容、并发症3方面进行效果评估.结果 ①功能评估：本组58只患眼,欠矫2只,正矫53只,过矫3只.LF术前平均为2.5 mm,术后为6.1 mm,术前平均MRD值为0.1 mm,术后为3.8 mm.术前后比较差异均有统计学意义（P〈0.05）.②美容效果评估：优88.64％,良6.81％,差4.54％.③并发症评估：欠矫、过矫者均给予再次修复手术,术后发生暴露性角膜炎1例,给予保守治疗后恢复.结论 联合筋膜鞘悬吊术治疗先天性中重度上睑下垂安全有效,远期效果好.

Objective To investigate the functional and cosmetic outcomes of conjoint fascial sheath（CFS） suspension surgery in pediatric congenital ptosis.Methods Forty-four moderate to severe ptosis patients（58 eyes） underwent CFS suspension surgery from December 2013 ot December 2014.With 12 to 36 months follow-up,the levator function,margin reflx distance,curve of upper eyelid,appearance and complications were recorded and analyzed,to evaluate the effect based on functionality,aesthetics and complication.Results ①Functional assessment：in the 58 eyes of 44 cases,the satisfactory rate was 91.4% （53 eyes）,2 eyes （3.45%） were under—corrected,3 eyes （5.17%） were over corrected.The mean preoperatively LF was 2.5 mm,which was increased postoperatively to 6.1 mm at the final visit.The average marginal reflex distance （MRD） was 0.1 mm preoperatively.After at least one year,average MRD was 3.8 mm （P 〈 0.05）.②Cosmetic satisfaction assessment：According to satisfaction surveys,the rate of excellence and good was 88.64%,6.81% fair,and 4.54% poor.③Complications：the most common complication was reoperation,which was performed in 2 eyelids （3.45 %） because of incomplete correction and 3 eyes（5.17%） over corrected.Only one case of cornea exposure which recovered after conservative treatment.Conclusions CFS suspension was an effective treatment for moderate-severe congenital ptosis,showing good long term result.