不同术式治疗退行性下睑内翻的临床效果分析

Efficacy Analysis of Different Surgical Methods in the Treatment of Involutional Lower Eyelid Entropion

目的分析2种不同术式治疗退行性下睑内翻的临床疗效。方法选取2017年3月—2020年9月在首都医科大学宣武医院诊治的退行性下睑内翻患者84例(86只眼)。按照随机数字表法分为加固组41例(42只眼)和前徙组43例(44只眼)。加固组予下睑缩肌加固联合睑板前轮匝肌缩短术;前徙组予下睑缩肌前徙联合外侧睑板条固定术。比较2组的手术时间、术后眼睑瘀血持续时长、复发率和临床疗效。结果(1)2组术前下睑前方牵拉试验、下睑侧方牵拉试验和下睑缩肌松弛试验阳性率比较,差异均无统计学意义(P>0.05)。(2)手术时间:加固组手术时间低于前徙组,差异有统计学意义(t=32.444,P=0.000)。(3)术后眼睑瘀血持续时长:加固组术后眼睑瘀血持续时长低于前徙组,差异有统计学意义(t=5.544,P=0.000)。(4)复发率和临床疗效:2组复发率和临床疗效比较,差异均无统计学意义(P>0.05),且术后均未出现严重并发症。结论下睑缩肌加固联合睑板前轮匝肌缩短术和下睑缩肌前徙联合外侧睑板条固定术均是治疗退行性下睑内翻的有效方法。但下睑缩肌加固联合睑板前轮匝肌缩短术具有手术步骤简单、手术用时短、术后眼睑瘀血轻等优点。

OBJECTIVE To analyze the clinical efficacy of two surgical methods in the treatment of involutional lower eyelid entropion.METHODS A total of 84 patients(86 eyes)diagnosed with involutional lower eyelid entropion at Xuanwu Hospital of Capital Medical University from March 2017 to September 2020 were included.According to the random number table method,they were divided into the reinforcement group(41 patients,42 eyes)and the anterior advancement group(43 patients,44 eyes).In the reinforcement group,patients received lower eyelid retractors reinforcement combined with lateral tarsal strip shortening.In the anterior advancement group,patients underwent lower eyelid retractors anterior advancement combined with lateral tarsal strip fixation.The surgical time,duration of postoperative eyelid ecchymosis,recurrence rate,and clinical efficacy were compared between the two groups.RESULTS(1)There was no significant difference in the positive rates of preoperative snapback test,lateral distraction test,and lower eyelid laxity test between the two groups(P>0.05).(2)Surgical time:The surgical time of the reinforcement group was lower than that of the anterior advancement group,and the difference was statistically significant(t=32.444,P=0.000).(3)Duration of postoperative eyelid ecchymosis:The duration of postoperative eyelid ecchymosis of the reinforcement group was lower than that of the anterior advancement group,and the difference was statistically significant(t=5.544,P=0.000).(4)Recurrence rate and clinical efficacy:There was no significant difference in recurrence rate and clinical efficacy between the two groups(P>0.05),and no serious complications appeared after the surgery.CONCLUSIONS Both lower eyelid retractors reinforcement combined with lateral tarsal strip shortening and lower eyelid retractors anterior advancement combined with lateral tarsal strip fixation are effective methods for treating involutional lower eyelid entropion.However,lower eyelid retractors reinforcement combined with lateral tarsal strip shortening has advantages such as simpler surgical steps,shorter surgical time,and less postoperative eyelid ecchymosis.