提上睑肌高位前徙术治疗中重度上睑下垂

High position advancement of levator palpebrae superioris muscle in the treatment of moderate to severe upper eyelid ptosis

目的探讨提上睑肌高位前徙术治疗中重度上睑下垂的临床效果。方法自2018年6月至2020年10月,潍坊医学院整形外科研究所收治中重度上睑下垂患者53例,均行提上睑肌高位前徙术治疗。自眶隔后壁及提上睑肌腱膜间疏松组织分离至Whitnall氏上部横韧带,切断提上睑肌腱膜-米勒氏肌;然后向上分离,形成一个游离矩型瓣,缝合于睑板上,使提上睑肌腱膜形成瓦合样结构;嘱患者睁眼观察效果,效果满意后缝合。结果53例患者获随访6~18个月,术后上睑均矫正到满意位置,双侧对称,无闭合不全、成角畸形、暴露性角膜炎等并发症发生。术后6个月与术后1个月上睑位置比较,基本未变。结论提上睑肌高位前徙术对中重度上睑下垂矫正效果较好,较好的控制了常见的上睑下垂术后并发症的发生,术式操作便捷,复发率低,值得临床推广应用。

Objective To explore the clinical efficacy ofhigh position advancement of levator palpebrae superioris muscle in the treatment of moderate to severe upper eyelid ptosis.Methods From June 2018 to October 2020,53 patients with moderate to severe upper eyelid ptosis underwent high position advancement of levator palpebrae superioris muscle.Separated the loose tissue between the posterior wall of orbital septum and the aponeurosis of levator palpebrae superioris muscle to Whitnall’s upper ligament.Cut off the levator aponeurosis-Müller muscle,and then separated upward to form a free rectangle flap,which was sutured on the eyelid plate to form an overlapping structure.Suture was performed after patients satisfied with the efficacy.Results All patients were followed-up for 6 to 18 months.The upper eyelids of 53 patients were corrected to a satisfactory position,symmetrical on both sides,without incomplete closure,angular deformity and exposed corneal diseases.The upper eyelid position was stable at 6 months after operation.Conclusion The high position advancement of levator palpebrae superioris muscle could correct moderate to severe upper eyelid ptosis.The efficacy is good,and the postoperative complications are controlled.The operation is convenient and the recurrence is low.It should be considerable for clinical promotion and application.