经结膜入路眼袋并睑眶沟畸形矫正术的临床效果

Clinical efficacy of transconjunctival lower eyelid blepharoplasty on correction of the eyelid orbital sulcus deformity

目的探讨经结膜入路眼袋并睑眶沟畸形矫正术的临床经验。方法2016年6月至2018年7月,南京中医药大学附属江苏省中医院整形美容科收集去除眼袋和睑眶沟畸形矫正患者67例,其中男3例、女64例;年龄18~28岁,平均22岁。均为下睑袋伴不同程度的眶隔后脂肪疝出,无或轻度下睑皮肤松弛;不同程度的睑眶沟呈现,骨性眶缘轮廓感,或伴有眶下区的发育不足。采用经结膜入路或附加外眦切口,于下睑前壁后方暴露脂肪团,释放弓状缘,眶隔脂肪带蒂转移至睑眶沟间隙并固定于眶下缘。眶隔后脂肪不足者以耳后筋膜移植补充。结果67例患者术后均顺利恢复,术区均无血肿、感染,结膜切口愈合良好,无下睑退缩、睑缘外翻等现象。随访>3个月,其中63例患者眼袋隆起及睑眶沟凹陷畸形明显改善,动态(轮匝肌收缩)表情下睑形态未出现局部隆起现象;另有3例双侧,1例单侧仍然存在轻度脂肪膨出眼袋畸形。结论经结膜入路眼袋并睑眶沟畸形矫正术可获得下睑眶区良好的效果。

Objective To investigate the clinical experience about the transconjunctival lower eyelid blepharoplasty with correction of the eyelid orbital sulcus deformity.Methods This group received 67 cases from June 2016 to July 2018,including 3 males and 64 females.The average age was 22 years.All the cases were diagnosed as lower eyelid bag with different degrees of fat herniation after orbital septum,with no or slight lower eyelid skin relaxation.Orbital sulcus of different degree appeared with outline of bony orbital margin,or accompanied by underdevelopment of the suborbital region.Through a transconjunctival incision or with short external canthal incision,the adipose mass was fully exposed behind the anterior wall of lower eyelid,the arcuate edge was released,and the pedicled orbital fat was transferred to the gap between the orbital eyelid sulcus and fixed in the lower orbital margin.If there was insufficient fat behind the orbital septum,a retroauricular fascia graft was used to make up.Results No postoperative complications occured in all cases.After followed up for more than 3-month,3 of 67 cases showed mild fat bulging pouch deformity in bilateral eyelids and 1 case was in unilateral eyelid.In other cases,deformity of the pouch and the eyelid orbital sulcus were improved significantly,and dynamic expression(orbicularis muscle contraction)showed no local uplift in lower eyelid morphology.Conclusion The transconjunctival lower eyelid blepharoplasty with correction of the eyelid orbital sulcus deformity can obtain good clinical results in lower eyelid area.