三种术式治疗老年性睑内翻的美学效果对比

Comparison of Aesthetic Effect of Three Surgical Methods in the Treatment of Senile Entropion

目的:探究眼轮匝肌折叠缩短联合睑袋去除术、眼轮匝肌切除术、睑缘间切开术治疗老年性睑内翻的美容效果。方法:回顾性分析笔者医院的380例老年性睑内翻患者资料,其中127例行眼轮匝肌折叠缩短联合睑袋去除术为折叠缩短组,127例行眼轮匝肌切除术为匝肌切除组,126例行睑缘间切开术为睑缘间切开组。比较三组围手术期指标、术后并发症、眼部功能、手术满意度及随访复发率。结果:与折叠缩短组比,匝肌切除组及睑缘间切开组手术时间、住院时间均显著延长,术中出血量均显著增加,各组间对比差异均有统计学意义(P<0.05)。与折叠缩短组相比,匝肌切除组与睑缘间切开组术后并发症发生率均较高,且三组总并发症发生率比较差异均有统计学意义(P<0.05)。三组术后眼表疾病指数量表(OSDI)评分、泪液分泌试验(SIT)值、泪膜破裂时间(BUT)值均较术前显著升高(P<0.05),且治疗后各组间对比差异均有统计学意义(P<0.05)。折叠缩短组手术满意度为97.64%,匝肌切除组为93.70%,睑缘间切开组为88.89%,三组间对比差异均有统计学意义(P<0.05)。术后随访1年,折叠缩短组出现2例复发,占比1.57%,匝肌切除组出现6例复发,占比4.72%,睑缘间切开组出现10例复发,占比7.94%,三组间对比差异显著(χ^(2)=5.67,P<0.05)。结论:与眼轮匝肌切除术、睑缘间切开术相比,眼轮匝肌折叠缩短联合睑袋去除术具有操作简单、术后恢复快、手术效果明显、远期疗效稳定等特点,值得推荐。

Objective To explore the cosmetic effect of orbicularis muscle folding shortening combined with eye bag removal,orbicularis muscle resection and eyelid margin incision in the treatment of senile entropion.Methods A retrospective analysis was performed on the data of 380 elderly patients with entropion in the hospital.127 cases who underwent orbicularis muscle fold shortening combined with eye bag removal were included in fold shortening group,and 127 cases who received orbicularis muscle resection were selected as orbicularis muscle resection group and 126 cases receiving eyelid margin incision were set as eyelid margin incision group.The perioperative indicators,postoperative complications,eye function,surgical satisfaction and follow-up recurrence rate were compared among the three groups.Results Compared with the folding shortening group,the operation time and hospital stay of the orbicularis muscle resection group and the blepharotomy group were significantly prolonged,and the amount of intraoperative bleeding was significantly increased,there were significant difference between the groups (P<0.05).Compared with the folding shortening group,the incidence of postoperative complications in the orbicularis muscle resection group and the blepharotomy group were higher,and the difference in the total incidence of complications among the three groups was statistically significant (P<0.05).The postoperative the score of OSDI,the value of SIT and BUT of the three groups were significantly higher than those before operation (P<0.05),and there were significant differences among the three groups after treatment (P<0.05).The satisfaction of folding shortening group was 97.64%,orbicularis muscle resection group was 93.70%,and blepharotomy group was 88.89%.There were significant differences among the three groups (P<0.05).After one year of follow-up,2 cases recurred in the folding shortening group,accounting for 1.57%,6 cases recurred in the orbicularis muscle resection group,accounting for 4.72%,and 10 cases recurred in the blepharotomy group,accounting for 7.94%.There was significant difference between the three groups (χ^(2)=5.67,P<0.05).Conclusion Compared with the orbicularis muscle resection and eyelid margin incision,orbicularis muscle fold shortening combined with eye bag removal has the characteristics of simpler operation,quicker postoperative recovery,more obvious surgical effect and more stable long-term efficacy,thus it is worth recommending.