摘要
目的:探讨关于重度瘢痕性睑外翻个性化手术治疗的影响因素,为该类患者的临床个性化治疗提供参考。方法:收集1例烧伤后双眼上、下睑重度外翻29年并患暴露性角膜炎患者的临床资料,采用水平缩短眼睑后层和全厚皮片移植的手术方法进行治疗。分析患者的诊疗过程并进行文献复习。结果:患者,女性,33岁,因“烧伤致双眼上、下睑外翻29年,加重1年”就诊于本院。眼科查体显示眼睑前层皮肤和轮匝肌严重缺失及眼睑后层睑板和睑结膜水平延长,诊断为瘢痕性睑外翻和暴露性角膜炎。手术避免上、下睑的手术切口相连,扩大松解瘢痕的范围至内侧超过内眦角接近鼻根部,外侧超过外眦角,上、下方达到眶缘,水平缩短眼睑后层,4块全厚皮片移植分别修复上、下睑的前层缺损。术后14 d移植皮片呈现正常肤色,眼睑形态良好,与眼球表面贴合紧密;术后12个月复查,皮片完全成活,无色素沉着;眼睑形态正常、无外翻,活动度良好;角膜溃疡修复,视力提高,患者对术后外观满意。结论:对于重度瘢痕性睑外翻患者,瘢痕牵拉的彻底松解、眼轮匝肌的最大限度保留和加强、睑板的选择性切除和皮瓣或皮片尺寸及厚度确定均为个性化治疗中必须重视的因素。临床上需全面评估患者情况,综合考量术式选择和手术细节,以达到理想的手术效果。
Objective:To discuss the influencing factors of individualized surgical treatment for the severe cicatricial ectropion,and to provide the reference for the personalized clinical treatment of such patients.Methods:The clinical data of one patient who suffered from severe ectropion of both upper and lower eyelids for 29 years and exposure keratitis after burn injury were reported.The treatment included horizontal shortening of the eyelid posterior layer and full-thickness skin grafting.The diagnosis and treatment processes of the patient was analyzed,and the literatures were reviewed.Results:The female patient,33 years old,was admitted to our hospital for“burn-induced ectropion of both upper and lower eyelids for 29 years,aggravated in the past year”.The ophthalmic examination results showed significant loss of anterior skin and orbicularis oculi muscle and horizontal elongation of the posterior layer of the eyelid and conjunctiva,diagnosed as cicatricial ectropion and exposure keratitis.The operation avoided the connection of upper and lower eyelid incisions,extended the range of scar loosening to the medial side near the nasal root beyond the inner canthus, the lateral side beyond the outer canthus, and reached the orbitalrim on the upper and lower sides. The horizontal shortening of the eyelid posterior layer was performed,and four full-thickness skin grafts were used to repair the anterior layer defects of the upper and lowereyelids. On the 14th day after operation, the grafts showed normal skin color, good eyelid morphology,and tight adhesion to the ocular surface;in the 12th month after operation, the grafts were completelyalive, without pigmentation deposition;the eyelid morphology was normal,and there were no ectropion andgood mobility;the corneal ulcer was healed, the visual acuity was improved, and the patient was satisfiedwith the postoperative appearance. Conclusion: For the patients with severe cicatricial ectropion,completing the loosening of scar traction, maximum preservation and reinforcement of orbicularis oculimuscle, selective excision of tarsal plate, and determination of flap or graft size and thickness are theessential factors in the personalized treatment. Clinically, the conditions of the patient should becomprehensive assessmented combined with the surgical procedure selection and surgical details,which isneeded to achieve the desired surgical outcomes.
作者
张锐
于澎
张浩
董雅儒
裴颖
ZHANG Rui;YU Peng;ZHANG Hao;DONG Yaru;PEI Ying(Department of Ophthalmology,Second Hospital,Jilin University,Changchun 130022,China)
出处
《吉林大学学报(医学版)》
CAS
CSCD
北大核心
2023年第6期1615-1619,共5页
Journal of Jilin University:Medicine Edition
基金
吉林省科技厅科研项目(YDZJ202201ZYTS525,20230203095SF)。
关键词
瘢痕性睑外翻
暴露性角膜炎
全厚皮片移植
烧伤
病例报告
Cicatricial ectropion
Exposure keratitis
Full-thickness skin graft
Burn injury
Case report