不同成因睑袋修复术式的效果

Effects of lower eyelid blepharoplasty on palpebral bags with different etiology

目的探讨对不同人群采取不同的下睑袋修复术的效果,方法2016年5月至2018年5月.中国医学科学院整形外科医院整形七科收治下睑袋修复患者102例.其中男20例,女82例,年龄21〜65岁,平均45.2岁。单纯下睑内容物膨出(1类术式)用减容手术,内容物膨出伴下睑皮肤松弛(2类术式)用减容+提升术式.眼轮匝肌肥厚(3类术式)用提拉术式.眼轮匝肌肌力减弱(4类术式)用重塑术式,皮肤松弛、皱纹、皱襞形成(5类术式)用去皮术式。结果Ⅰ类术式32例患者切U愈合良好.随访>3个月下睑袋改善明显。2类术式8例切口愈合良好,随访>3个月下睑袋明显改善,下睑皮肤较术前紧致;3类术式19例切口愈合良好.随访>3个月.下睑袋改善明显,静态及动态表情下末见局部膨出;4类术式3.1例切口愈合良好.随访>3个月下睑袋畸形及下睑皮肤松弛得到较大改善.除1例可见轻度膨出外(未处理).其余效果较好;5类术式9例手术切口愈合良好.随访>3个月下睑皮肤皱褶消失,皮肤平整紧致.效果较好。结论可个性化采取手术方法.恰到好处地上,除睑袋.最大程度上实现患者眼部年轻化效果。

Objective To address a new classification method in term of the three-dimensional space of orbit and to present the different surgical approaches correspondingly.Methods In a retro sped study from April of 2015 to June of 2018.102 patients were performed lower eyelid blepharo-plasty«including 20 males and 82 females,aged 21-65 years,with an average of 45.2 years.These patients were divided into five groups,which were described in term of three-dimensional structure of orbit.based on the following points:the presence and extent of herniated orbital fat,the presence of inferior orbitopalpebral sulcus,amount of excess skin,and the skin wrinkles in the lower eyelid.And then patients in different group were treated with different kinds of hlepharoplasty.All patients in this study ranged in follow-up from 1 month to 12 months.With patients permit,photographs and clinical information were taken to evaluate the preoperative and postoperative outcome.Results In type 1,all the 32 cases healed well,no complications such as hematoma,infection and ectropion occurred.During the follow-up of more than 1 months,the overall effect was good,and the pouch-shaped appearance of lower eyelid pouch was significantly improved.In types 2»8 cases had no complications,and the incision healed well;the patients were followed up for more than 3 months,the lower eyelid bag and lower eyelid skin relaxation were significantly improved,and the lower eyelid skin was tighter than before.In types 3,there were no complications in these 19 cases,and the incision was healed well.The patients were followed up for more than 3 months,the deformity of lower eyelid bag was improved obviously and no obvious local bulge was found under static and dynamic expression.In type 4,there were no complications in all 34 cases»and the incision healed well;during the follow-up of more than 3 months,the lower eyelid pouch deformity and lower eyelid skin relaxation were greatly improved,except for 1 case with mild bulge(untreated).In type 5,9 cases had no complications,and the incision healed well;during the follow-up of more than 3 months,the fold of the lower eyelid skin disappeared.Conclusions Little information is available about classification of lower eyelid bags.And the exact surgical approach remains controversial and largely dependent upon surgeon preference and a patient's stated cosmetic desire.In this study,an objective classification based on clinical appearance combined with forming reasons of lower eye bags is little available,and the appropriate surgical approach remains controversial as well.