三种方法矫正中重度上睑皮肤松弛效果的比较分析

Clinical efficacy comparison of three methods for correction of moderate and severe upper eyelid skin laxity

目的比较分析3种不同的手术方法矫正中、重度上睑皮肤松弛的临床效果。方法回顾分析2017年1月至2019年3月空军军医大学西京医院整形外科采用眉下切口提眉术(subbrow blepharoplasty,SBB),重睑成形术(double eyelid surgery,DES)和眉下切口提眉术联合重睑成形术(combination of subbrow blepharoplasty and double eyelid surgery,CSD)3种方法矫正中、重度上睑皮肤松弛的患者资料。根据手术方式的不同及纳入和排除标准将患者分为SBB组、DES组和CSD组。评价患者术后6个月上睑皮肤松弛改善效果,包括睑缘-角膜映光点距离(MRD1)、角膜内侧睑缘与重睑褶皱距离(MCMFD)、瞳孔中点睑缘与重睑褶皱距离(MPMFD)、外眦处睑缘与重睑褶皱距离(LCMFD),以及上睑皱纹改善效果,并由患者和第三方医师进行视觉模拟评分(VAS)评价。计量资料用均值±标准差表示,组间比较采用单因素方差分析,组间两两比较采用LSD-t检验。P<0.05为差异有统计学意义。结果90例女性患者被纳入研究,每组30例,患者年龄35~62岁,3组患者年龄及上睑皮肤松弛程度差异无统计学意义(P>0.05)。术后随访6~24个月,所有患者术后上睑皮肤松弛和上睑皱纹均得到改善。CSD组2例患者出现呕吐,1例患者出现额部皮肤麻木。SBB组、DES组和CSD组MRD1改善量分别为(0.14±0.09)mm、(0.34±0.11)mm、(0.43±0.15)mm,3组组间比较差异有统计学意义(F=34.537,P<0.001),SBB组与DES组、DES组与CSD组、SBB组与CSD组比较,差异均有统计学意义(t值分别为6.418、2.824、9.236,P值分别为<0.001、0.008、<0.001);MCMFD改善量分别为(0.32±0.15)mm、(0.92±0.21)mm、(0.97±0.24)mm,3组组间比较差异有统计学意义(F=94.082,P<0.001),SBB组与DES组、SBB组与CSD组比较,差异均有统计学意义(t值分别为11.273、12.404,P值均<0.001),DES组与CSD组比较差异无统计学意义(t=1.132,P=0.261);MPMFD改善量分别为(0.34±0.13)mm、(1.07±0.24)mm、(1.37±0.23)mm,3组组间比较差异有统计学意义(F=193.935,P<0.001),SBB组与DES组、DES组与CSD组、SBB组与CSD组比较,差异均有统计学意义(t值分别为13.531、5.628、19.159,P值均<0.001);LCMFD改善量分别为(0.54±0.17)mm、(1.58±0.37)mm、(1.97±0.48)mm,3组组间比较差异有统计学意义(F=121.405,P<0.001),SBB组与DES组、DES组与CSD组、SBB组与CSD组比较,差异均有统计学意义(t值分别为10.971、4.097、15.068,P值均<0.001)。上睑皱纹评分改善量:SBB组、DES组、CSD组分别为(0.70±0.47)分、(0.50±0.51)分、(1.20±0.48)分,3组组间比较差异有统计学意义(F=16.471,P<0.001);SBB组与DES组比较,差异无统计学意义(t=1.592,P=0.115),DES组与CSD组、SBB组与CSD组比较,差异均有统计学意义(t值分别为5.571、3.979,P值均<0.001)。SBB组、DES组和CSD组VAS患者评分分别为(2.77±0.57)分、(2.17±0.38)分、(3.90±0.31)分,3组组间比较差异有统计学意义(F=124.575,P<0.001),SBB组与DES组、DES组与CSD组、SBB组与CSD组比较,差异均有统计学意义(t值分别为5.379、15.541、10.161,P值均<0.001)。VAS医师评分分别为(2.80±0.61)分、(2.27±0.58)分、(4.07±0.45)分,3组组间比较差异有统计学意义(F=84.085,P<0.001),SBB组与DES组、DES组与CSD组、SBB组与CSD组比较,差异均有统计学意义(t值分别为3.740、12.624、8.883,P值均<0.001)。结论相较于眉下切口提眉术和重睑成形术,眉下切口提眉术联合重睑成形术能够充分切除上睑松弛皮肤,明显减少上睑皱纹,调整和重塑重睑形态,恢复良好的眉眼部美学关系,是矫正中、重度上睑皮肤松弛的更好方法。

Objective To compare and analyze the clinical appplication and therapeutic effect of applying three methods for correction of moderate and severe upper eyelid skin laxity.Methods From January 2017 to March 2019,retrospective analysis was performed to evaluate the therapeutic effect of applying three methods by Department of Plastic Surgery at Xijing Hospital of Air Force Medical University to correct moderate and severe upper eyelid skin laxity,such as subbrow blepharoplasty(SBB),double eyelid surgery(DES)and combination of subbrow blepharoplasty and double eyelid surgery(CSD).Patients were divided into the SBB group,DES group,and CSD group according to the different surgical methods,inclusion and exclusion criteria.The 6 month postoperative improvement of upper eyelid skin laxity,including marginal reflex distance 1(MRD1),medial corneal margin-fold distance(MCMFD),middle pupil margin-fold distance(MPMFD),lateral canthus margin-fold distance(LCMFD),the improvement of upper eyelid wrinkles and patient and surgeon visual analog scores(VAS)were compared.Measurement data were expressed as mean±standard deviation,comparison between groups was performed by ANOVA,pairwise comparison between groups was performed by LSD-t test,P<0.05 was considered statistically significant.Results Ninety female patients were included in this study.Thirty patients in each group,patients were between 35 and 62 years old.There was no significant difference in gender,age,and degree of upper eyelid skin laxity among the three groups(P>0.05).All patients were followed up for 6 to 24 months.Upper eyelid skin laxity and upper eyelid wrinkles were obviously improved in all cases after operation.With the exception of 2 cases of vomiting and 1 case of scalp numbness of CSD group.The improvement of MRD1 in SBB group,DES group and CSD group was(0.14±0.09)mm,(0.34±0.11)mm,(0.43±0.15)mm,showing significant difference between three groups(F=34.537,P<0.001).The differences between the SBB group and the DES group,the DES group and the CSD group,and the SBB group and the CSD group were statistically significant(t=6.418,2.824,9.236,P<0.001,0.008,<0.001).The improvement of MCMFD in SBB group,DES group and CSD group was(0.32±0.15)mm,(0.92±0.21)mm,(0.97±0.24)mm,showing significant difference between three groups(F=94.082,P<0.001).The differences between the SBB group and the DES group,the SBB group and the CSD group were statistically significant(t=11.273,12.404,P<0.001),and there was no significant difference between the DES group and the CSD group(t=1.132,P=0.261).The improvement of MPMFD in SBB group,DES group and CSD group was(0.34±0.13)mm,(1.07±0.24)mm,(1.37±0.23)mm,showing significant difference between three groups(F=193.935,P<0.001).The differences between the SBB group and the DES group,the DES group and the CSD group,and the SBB group and the CSD group were statistically significant(t=13.531,5.628,19.159,P<0.001).The improvement of LCMFD in SBB group,DES group and CSD group was(0.54±0.17)mm,(1.58±0.37)mm,(1.97±0.48)mm,showing significant difference between three groups(F=121.405,P<0.001).The differences between the SBB group and the DES group,the DES group and the CSD group,and the SBB group and the CSD group were statistically significant(t=10.971,4.097,15.068,P<0.001).The improvement of upper eyelid wrinkles in SBB group,DES group and CSD group was 0.70±0.47,0.50±0.51,1.20±0.48,showing significant difference between three groups(F=16.471,P<0.001).There was no significant difference between the SBB group and the DES group(t=1.592,P=0.115),while the differences between the DES group and the CSD group,and the SBB group and the CSD group were statistically significant(t=5.571,3.979,P<0.001).The VAS patients score in SBB group,DES group and CSD group was 2.77±0.57,2.17±0.38,3.90±0.31,showing significant difference between three groups(F=124.575,P<0.001).The differences between the SBB group and the DES group,the DES group and the CSD group,and the SBB group and the CSD group were statistically significant(t=5.379,15.541,10.161,P<0.001).The VAS surgeons score was 2.80±0.61,2.27±0.58,4.07±0.45,showing significant difference between three groups(F=84.085,P<0.001).The differences between the SBB group and the DES group,the DES group and the CSD group,and the SBB group and the CSD group were statistically significant(t=3.740,12.624,8.883,P<0.001).Conclusions Compared with subbrow blepharoplasty and double eyelid surgery,the combination of subbrow blepharoplasty and double eyelid surgery is an effective way to excise upper eyelid skin and reduce wrinkles,which has the best results in promoting upper eyelid rejuvenation.It should be considered as optimal method for correction of moderate and severe upper eyelid skin laxity.