辅助结膜面入路在上睑联合筋膜鞘技术矫正重度上睑下垂中的应用

Application of auxiliary conjunctival approach technique in the correction of severe ptosis with conjoint fascial sheath technique

目的:探索辅助结膜面入路在上睑联合筋膜鞘(CFS)技术矫正重度上睑下垂中应用的可行性。方法:回顾性分析合肥市第二人民医院整形外科收治的采用辅助结膜面入路(2021年1至12月)或角膜保护板(2020年1至12月)实施的CFS技术矫正重度上睑下垂患者的临床资料。将采用辅助结膜面入路和采用角膜保护板实施手术的患者分别定义为Ⅰ组和Ⅱ组。分别统计2组的手术总时长、暴露CFS所需时间、术后消肿时间、并发症发生情况,并进行术后患者满意度调查。正态分布计量资料以±s表示,两组间比较采用独立样本t检验;计数资料采用卡方检验进行分析。结果:共纳入43例重度上睑下垂患者,其中Ⅰ组25例,男3例,女22例,共计47只眼,年龄(55.1±10.0)岁,上睑下垂量为(5.9±0.9)mm;Ⅱ组18例,男4例,女14例,共计34只眼,年龄(49.9±12.7)岁,上睑下垂量为(5.5±1.2)mm。2组的年龄、性别构成及上睑下垂量比较,差异均无统计学意义(P均>0.05)。Ⅰ组暴露CFS所需时间[(15.6±2.8)min vs.(27.3±5.3)min]和手术总时长[(28.3±3.9)min vs.(48.6±8.2)min]均明显少于Ⅱ组,差异有统计学意义(P均<0.01)。Ⅰ组的术后消肿时间较Ⅱ组明显缩短[(13.5±2.4)d vs.(30.2±4.5)d,P<0.01]。Ⅰ组并发症发生率明显小于Ⅱ组[6.38%(3/47)vs.26.47%(9/34),P<0.05]。Ⅰ组术后满意率高于Ⅱ组[88.00%(22/25)vs.55.56%(10/18),P<0.05]。结论:采用辅助结膜面入路分离技术有利于提高重度上睑下垂患者CFS分离效率,减少手术时间,降低术后并发症的发生率。

Objective To explore the feasibility of auxiliary conjunctival approach technique in the correction of severe ptosis with upper eyelid conjoint fascial sheath(CFS)technique.MethodsThe clinical data of patients with severe blepharoptosis who were treated in the Department of Plastic Surgery of the Second People’s Hospital of Hefei with CFS technology using auxiliary conjunctival approach(January to December 2021)or corneal protective plate technology(January to December 2020)were analyzed retrospectively.The patients were divided into groupⅠ(using the auxiliary conjunctival approach)and groupⅡ(using the corneal protection plate technique).The total operation time,CFS exposure time,postoperative tumescence time and complications of the two groups were recorded,and the postoperative patient satisfaction was investigated.The measurement data of normal distribution were expressed as Mean±SD,and independent samplet-test was used for comparison between the two groups.Counting data were analyzed by Chi-square test.ResultsA total of 43 cases of severe blepharoptosis were included.There were 25 cases(47 eyes)in groupⅠ,aged(55.1±10.0)years,including 3 males and 22 females.The amount of blepharoptosis was(5.9±0.9)mm.There were 18 cases(34 eyes)in groupⅡ,aged(49.9±12.7)years,including 4 males and 14 females.The amount of ptosis was(5.5±1.2)mm.There were no significant differences in age,gender composition and ptosis between the two groups(P>0.05).The CFS exposure time[(15.6±2.8)min vs.(27.3±5.3)min]and the total operation time[(28.3±3.9)min vs.(48.6±8.2)min]in groupⅠwere significantly less than those in groupⅡ,with significant differences(P<0.01).The postoperative tumescence time in groupⅠwas significantly shorter than that in groupⅡ[(13.5±2.4)days vs.(30.2±4.5)days,P<0.01].The incidence of complications in groupⅠwas significantly lower than that in groupⅡ[6.38%(3/47)vs.26.47%(9/34),P<0.05].The postoperative satisfaction rate in groupⅠwas higher than that in groupⅡ[88.00%(22/25)vs.55.56%(10/18),P<0.05].ConclusionThe use of auxiliary conjunctival approach separation technology is effective for dissection of CFS in correction of severe blepharoptosis,so as to reduce the operation time and the incidence of postoperative complications.