上睑松垂的分类和治疗策略

Classification and treatment of upper eyelid laxity

目的观察不同术式矫治上睑松垂的临床效果,探讨各术式在不同程度上睑松垂及眉位置不同的患者中的应用策略。方法对吉林大学第一医院2014年1月至2020年9月收治的上睑松垂患者,根据上睑松垂的程度和是否伴有眉下垂进行分类,对轻、中度上睑松垂不伴眉下垂患者采用去皮重睑术或眉下切口上睑松垂矫正术;对轻、中度上睑松垂伴眉下垂患者采用眉上切口上睑松垂矫正术;对重、特重度上睑松垂不伴眉下垂患者采用去皮重睑术联合眉下切口上睑松垂矫正术;对重、特重度上睑松垂伴眉下垂患者采用去皮重睑术联合眉上切口上睑松垂矫正术。观察手术效果并评估患者满意度。结果研究共纳入688例患者,其中男36例,女652例,年龄35~79岁,平均47.8岁。轻度及中度上睑松垂396例,伴眉下垂94例,不伴眉下垂302例;重度及特重度上睑松垂292例,不伴眉下垂156例,伴眉下垂136例。其中单纯去皮重睑术145例、眉下切口上睑松垂矫正术157例、眉上切口上睑松垂矫正术94例,联合手术292例。术后随访6~12个月,随访患者上睑皮肤松垂均有所改善,其中非常满意436例,满意225例,不满意27例,满意率96.1%(661/688)。其中,行联合手术满意率为98.6%(288/292)高于行单项手术满意度94.2%(373/396)。结论根据患者上睑皮肤松垂程度不同及是否伴有眉下垂选择不同术式,重度上睑皮肤松垂且伴有眉位置改变的患者通常需要联合手术方可达到满意的效果。

Objective To observe the clinical effects of different surgical methods in the treatment of upper eyelid aging,and to explore the strategies of different surgical methods in patients with different degrees of upper eyelid relaxation and different eyebrow positions.Methods From January 2014 to September 2020,688 patients were selected,and different surgical procedures were performed according to their eyebrow shape and the degree of upper eyelid laxity,such as blepharoplasty skin excision,subeyebrow-incision skin excision,supraeyebrow-incision skin excision or combined procedure.The patients were followed up for 6 to 12 months and observed on the effect of the operation and evaluated on the satisfaction over the surgery.Results In a total of 688 patients,396 patients presented mild and moderate blepharoptosis,292 patients presented severe and extra severe blepharoptosis without eyebrow ptosis.There were 145 cases of double eyelid peeling,157 cases of upper blepharoptosis correction with subeyebrow incision,94 cases with upper blepharoptosis with superior eyebrow incision,and 292 cases with combined operation.In the postoperative follow-up,the upper eyelid skin ptosis was improved in 436 cases,satisfactory in 225 cases and dissatisfied in 27 cases,the satisfaction rate was 96.1%(661/688).The postoperative satisfaction of combined operation rendered 98.6%(288/292),higher than that of single operation 94.2%(373/396).Conclusions Different surgical methods should be applied according to the different degree of upper eyelid skin ptosis and the change of eyebrow position.Patients with severe upper eyelid skin ptosis and eyebrow position change usually need combined operation to achieve satisfactory results.