结膜上穹窿联合筋膜鞘悬吊术治疗先天性重度上睑下垂的临床观察

Clinical observation of conjunctival fornix combined with fascial sheath suspension in the treatment of congenital severe blepharoptosis

目的至2020年2月于我院就诊的86例先天性重度上睑下垂患者,采用随机数字表法分为两组,每组各43例。对照组采用额肌腱膜瓣悬吊术,观察组实施结膜上穹窿联合筋膜鞘悬吊术。术后随访6个月,分析患者矫正情况、上睑回缩量及并发症发生情况,以评估手术治疗效果。其中矫正情况以上睑缘位于角膜下1-2mm为完全矫正;上睑缘遮盖角膜2-3 mm为基本矫正;上睑缘遮盖瞳孔上缘为部分矫正;未达上述标准为未矫正。上睑回缩越小、并发症越少,手术效果越好。结果观察组治疗效果优于对照组,差异有统计学意义(Z=13.34,P=0.004)。两组术后1周上睑回缩量比较,差异无统计学意义(t=1.925,P=0.058);观察组术后6个月上睑回缩量(0.17±0.06)mm,小于对照组的(0.26±0.11)mm,差异有统计学意义(t=5.456,P=0.000)。观察组并发症发生率(4.65%)低于对照组(20.93%),差异有统计学意义(χ^(2)=5.108,P=0.024)。结论先天性重度上睑下垂患者应用结膜上穹窿联合筋膜鞘悬吊术治疗矫正效果较佳,且并发症较少,利于患者预后。

Objective To investigate the clinical effect of conjunctival fornix combined with fascial sheath suspension in the treatment of congenital severe ptosis.Methods From May 2018 to February 2020,86 patients with severe congenital ptosis were selected and randomly divided into two groups,43 cases in each group.The control group was treated with frontalis aponeurosis flap suspension,and the observation group was treated with superior conjunctival fornix combined with fascial sheath suspension.The patients were followed up for 6 months to evaluate the effect of surgery.Among them,the upper eyelid margin located 1-2 mm below the cornea is complete correction;the upper eyelid margin covering the cornea 2-3 mm is the basic correction;the upper eyelid margin covering the upper edge of the pupil is partial correction;failing to meet the above criteria is not corrected.The smaller the upper eyelid retraction and the fewer complications,the better the surgical effect.Results The treatment effect of the observation group was better than that of the control group(z=13.34,P=0.004).There was no significant difference in the upper eyelid retraction between the two groups 1 week after operation(t=1.925,P=0.058);the upper eyelid retraction of the observation group was(0.17+0.06)mm,which was smaller than that of the control group(0.26+0.11)mm,the difference was statistically significant(t=5.456,P=0.000).The incidence of complications in the observation group(4.65%)was lower than that in the control group(20.93%)(χ^(2)=5.108,P=0.024).Conclusion The application of conjunctival fornix combined with fascial sheath suspension in the treatment of congenital severe ptosis have better correction effect and fewer complications,which is conducive to the prognosis of patients.