经结膜入路下睑袋矫正术联合脂肪来源干细胞基质胶移植在眶下区年轻化中的效果分析

Effect analysis of transconjunctival lower blepharoplasty combined with stromal vascular fraction-gel transplantation in suborbital rejuvenation

目的探讨经结膜入路下睑袋矫正术联合脂肪来源干细胞基质胶(SVF-gel)移植在眶下区年轻化中的应用效果。方法回顾性分析2019年4月至2021年4月武汉市第一医院整形外科门诊收治的眶下区年轻化患者的临床资料。根据术前照片对泪沟畸形进行Hirmand分型。术中采用经结膜入路去除膨出的眶隔脂肪,同时抽取腹部或大腿脂肪制备SVF-gel,进行泪沟或眶下区凹陷注射填充治疗。术后对患者进行随访观察,记录手术相关并发症。术前、术后根据泪沟畸形等级量表(TTRS),分别对泪沟凹陷深度、色素沉着程度、颧脂肪垫下垂程度及下睑皮肤皱褶程度进行评分,总分越高提示泪沟畸形越严重;根据Barton美学评级标准,对眶-颊结合部的形态进行评级(0~3级);结合患者手术效果满意度调查表(非常满意、满意、不满意3个等级),综合分析患者下睑袋及泪沟矫治的美学效果。采用SPSS 22.0软件进行统计学分析,呈正态分布的计量资料用±s表示,术前、术后TTRS评分比较采用配对样本t检验,P<0.05为差异有统计学意义。结果共纳入92例双侧下睑袋伴泪沟或中面部凹陷患者。其中男15例,女77例,年龄(38.8±9.6)岁(21~55岁)。术前Hirmand泪沟分型:Ⅱ型37例、Ⅲ型55例。所有患者术后3 d均有不同程度结膜水肿及下睑肿胀,其中35例出现不同程度的皮肤淤斑,术后1~2周均自行恢复,均未出现血肿、复视、脂肪液化、脂肪结节及脂肪栓塞等并发症。术后随访6~12个月。术前、术后TTRS评分比较:与术前比较,Hirmand泪沟Ⅱ型患者[(2.37±0.78)分vs.(4.83±0.98)分,t=36.54,P<0.001]和Ⅲ型患者[(2.61±0.60)分vs.(5.38±0.93)分,t=55.20,P<0.001]的TTRS评分在术后均有明显降低,差异均有统计学意义。术前、术后Barton美学评级比较:对于HirmandⅡ型患者,术前评级为1级7例、2级19例、3级11例,术后改善为0级36例、1级1例;对于Hirmand Ⅲ型患者,术前评级为2级20例、3级35例,术后改善为0级50例、1级5例。术后患者满意度调查:非常满意85例(92.4%)、满意5例(5.4%)、不满意2例(2.2%)。2例不满意患者中1例因泪沟畸形改善效果不明显,3个月后行第2次SVF-gel填充,达到满意效果;1例患者因术后下睑外侧仍有睑袋,3个月后再次手术矫正,达到满意效果。结论对于无明显皮肤松弛的下睑袋伴泪沟或眶下区凹陷患者,采用经结膜入路下睑袋矫正术联合SVF-gel移植术治疗,可以达到眶下区年轻化的效果。

Objective To investigate the effect of transconjunctival lower blepharoplasty combined with stromal vascular fraction-gel(SVF-gel)transplantation in suborbital rejuvenation.Methods The clinical data of patients with suborbital rejuvenation who were admitted to the Department of Plastic Surgery,Wuhan No.1 Hospital from April 2019 to April 2021 were retrospectively analyzed.Hirmand classification of tear trough deformity was performed based on preoperative photographs.The expanded orbital septum fat was removed through the conjunctival approach,and the SVF-gel was extracted from the fat which was harvested from abdomen or thigh.The tear trough or suborbital depression was corrected by SVF-gel injection.The patients were followed up and the complications related to the operation were recorded.According to tear trough rating scale(TTRS),the depth of tear trough depression,the degree of pigmentation,the sagging degree of zygomatic fat pad and the degree of lower eyelid skin fold were scored before and after operation.The higher the total score indicates the greater severity of the lacrimal groove deformity.The morphology of the orbital-buccal junction was rated(0 to 3)according to the Barton aesthetic rating criteria.The aesthetic effects of lower eyelid bag and tear trough correction were comprehensively analyzed based on the satisfaction questionnaire(very satisfied,satisfied,dissatisfied 3 grades).SPSS 22.0 software was used for statistical analysis,and the normally distributed measurement data were represented by Mean±SD.Paired sample t-test was used to compare preoperative and postoperative TTRS scores,and P<0.05 was considered statistically significant.Results A total of 92 patients with bilateral lower eyelid bag accompanied by tear trough or middle facial depression were included.There were 15 males and 77 females,aged(38.8±9.6)years(21-55 years).Preoperative Hirmand tear trough classification was performed as typeⅡin 37 cases,as typeⅢin 55 cases.All patients had conjunctival edema and lower eyelid swelling of different degrees 3 days after surgery,among which 35 patients had skin ecchymosis of different degrees,which recovered spontaneously 1 to 2 weeks after surgery,and no complications such as hematoma,diplopia,fat liquefaction,fat nodule and fat embolism occurred.Postoperative follow-up was conducted for 6 to 12 months.Comparison of preoperative and postoperative TTRS scores:compared with preoperative results,the TTRS scores of Hirmand typeⅡpatients[(2.37±0.78)points vs.(4.83±0.98)points,t=36.54,P<0.001]and typeⅢpatients[(2.61±0.60)points vs.(5.38±0.93)points,t=55.20,P<0.001]were significantly decreased after surgery,and the differences were statistically significant.Comparison of Barton aesthetic rating before and after surgery:for Hirmand typeⅡpatients,preoperative rating was grade 1 in 7 cases,grade 2 in 19 cases,grade 3 in 11 cases,and postoperative improvement was grade 0 in 36 cases and grade 1 in 1 case;for Hirmand typeⅢpatients,preoperative ratings were grade 2 in 20 cases,grade 3 in 35 cases,and postoperative improvement was grade 0 in 50 cases,grade 1 in 5 cases.Postoperative patient satisfaction survey:85 cases(92.4%)were very satisfied,5 cases(5.4%)were satisfied,2 cases(2.2%)were dissatisfied.For the 2 patients who were not satisfied,one patient had no obvious improvement due to tear trough deformity,and was filled with SVF-gel for the second time 3 months later,achieving satisfactory results.One patient still had baggy eye on the outer side of the lower eyelid after surgery,which was corrected again 3 months later and achieved satisfactory results.Conclusion For patients with lower eyelid bag with tear trough or suborbital depression without obvious skin relaxation,lower eyelid bag correction through conjunctival approach combined with SVF-gel transplantation can achieve the effect of rejuvenation of the suborbital region.