改良式上睑提肌缩短术治疗上睑下垂66眼

The treatment of 66 ptosis with a modified aponeurosis-resection surgery

目的探讨改良式上睑提肌缩短术治疗轻、中度上睑下垂的临床效果。方法自2017年6月至2018年1月,浙江大学医学院附属邵逸夫医院共收治34例(66眼)轻、中度先天性上睑下垂患者,其中男2例,女32例,年龄(26.6±7.6)岁,轻度49眼,中度17眼。均行埋没导引法改良式上睑提肌缩短术治疗,术中通过引导缝线走行于上睑提肌-米勒氏肌复合体深面,将复合体前徙缝合固定于睑板上。随访观察患者术后并发症情况,记录术前、术后3、6、12个月时上睑缘遮盖角膜上缘的距离,方差分析法分析上睑下垂矫正效果。结果本组34例(66眼),术前、术后3、6、12个月上睑缘遮盖角膜距离分别为(3.84±0.79)mm、(1.64±0.13)mm、(1.67±0.14)mm、(1.68±0.14)mm。术后测量值与术前差异具有统计学意义(P<0.01),但术后各值间差异无统计学意义(P>0.05)。34例患者在随访期间均未观察到感染、倒睫、上睑迟滞、暴露性角膜炎、眼睑外翻、结膜脱垂等其他上睑下垂手术的并发症。1例出现重睑缝线脱落,予以修复,余33例患者上睑缘高度矫正满意,形态良好,双眼对称性可,其中2例(4眼)上睑缘高度出现轻微下降,但仍在正常范围,所有患者均对手术效果表示满意。结论改良式上睑提肌缩短术矫治轻、中度上睑下垂,操作简单,可形成稳定粘连,术后远期眼睑功能、形态良好。

Objective To explore the clinical effect of a modified aponeurosis-resection surgery.Methods From June 2017 to January 2018,a total of 34 patients(66 eyes)with mild to moderate congenital ptosis were treated in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,including 2 males and 32 females,(26.6±7.6)aged,with mild 49 eyes and moderate 17 eyes.All patients underwent a modified aponeurosis-resection surgery by buried guiding suture.During the operation,guided sutures were run on the deep surface of the levator-Muller’s muscle complex,and the complex was sutured and fixed on the tarsal plate.Follow-up of the postoperative outcome was performed.The distance between the upper eyelid margin covering the upper edge of the cornea was recorded before operation,3 months,6 months,and 12 months after operation.The correction of ptosis was analyzed by the analysis of variance.Results For the 34 patients(66 eyes),the distance between the upper eyelid margin covering the cornea before surgery,3 months,6 months,and 12 months was(3.84±0.79)mm,(1.64±0.13)mm,(1.67±0.14)mm,and(1.68±0.14)mm.The difference between the initial value and the preoperative value was statistically significant(P<0.01).During the follow-up period,no significant complications,such as infection,trichiasis,blepharoplasty,exposed keratitis,eyelid appearance,and conjunctival prolapse,were observed in all 34 patients.1 case of blepharoplasty suture was lost and then repaired.The remaining 33 patients had satisfactory correction of the upper eyelid,good apperance,and bilateral symmetry.Two of them(4 eyes)had a slight decrease in the upper eyelid margin height,but still normal range,all patients were satisfied with the surgical result.Conclusions The modified aponeurosis-resection surgery is effective in treating mild and moderate ptosis,with simple procedure,stable adhesion formation,and long-term eyelid function and appearance.