保留睑板前眼轮匝肌睑缘切口内固定法重睑术的临床应用

Blepharoplasty through palpebral margin incision with preservation of the pretarsal orbicularis oculi muscle

目的对保留睑板前眼轮匝肌睑缘切口内固定法重睑术进行改良,并探讨其临床应用效果。方法回顾性分析2021年8月至2023年8月于长沙爱思特医疗美容医院行保留睑板前眼轮匝肌睑缘切口内固定法重睑术的患者临床资料。沿上睑设计的2条去皮线切开皮肤,去除皮肤后沿去皮上线从眼轮匝肌下分离,于睑板上缘呈楔形适量修薄睑板前眼轮匝肌,从睑板上缘沿睑缘方向剥离睑板前眼轮匝肌;将睑板前筋膜或上睑提肌腱膜与重睑线位置的眼轮匝肌做内固定,确认重睑形态及对称性后缝合皮肤。术后对手术切口愈合、眼睑肿胀、并发症情况进行观察,对重睑形态进行随访;术后6个月,调查患者对手术效果的满意度(满意、比较满意、不满意),并用温哥华瘢痕量表(VSS)对上睑瘢痕情况进行评分(包括色泽、厚度、血管分布、柔软度),评分越高说明瘢痕越严重。结果共纳入78例单睑或隐性重睑患者,男6例,女72例,年龄18~40岁。所有患者均行改良保留睑板前眼轮匝肌睑缘切口内固定法重睑术,其中29例同时行上睑下垂矫正术,47例同时行内眦赘皮矫正术,术后切口均一期愈合。78例获得1~6个月随访,术后上睑有轻微肿胀,71例术后10~15 d消除,7例术后25~30 d消除。其中有61例获得6个月随访,患者重睑弧度均自然流畅,双侧基本对称,无重睑变浅、无睑板前组织堆积等不良表现,无眼睑闭合不全等并发症发生;57例对手术效果满意,4例比较满意。61例患者闭眼时切口瘢痕不明显,VSS评分均接近0分,色泽、厚度、血管分布、柔软度平均分分别为0.29、0、0.31、0分。结论该术式基本保留了全部睑板前眼轮匝肌,有利于眼部淋巴循环;选择眼轮匝肌做内固定,既可以更简单的操作来保障睑缘切口内固定法重睑术的效果,又可加速术后眼睑的恢复,减少眼睑闭合不全的发生。

Objective To modify the blepharoplasty through palpebral margin incision with preservaton of the pretarsal orbicularis oculi muscle,and to discuss the clinical application effects.Methods The clinical data of patients who underwent double-eyelid blepharoplasty through palpebral margin incision with preservation of the pretarsal orbicularis oculi muscle were retrospectively analyzed from August 2021 to August 2023 in Changsha Aist Medical Cosmetology Hospital.After the skin peeling rang was designed,the skin was removed,tissue was separated under the orbicularis oculi muscle.The pretarsal orbicularis oculi muscle was thinned-shaped at the upper edge of tarsus as wedge-shaped,and was detached from the upper edge of tarsus.The pretarsal fascia or levator aponeurosis was fixed internally with the orbicularis oculi muscle at the position of the double-eyelid crease.After confirming the shape and symmetry of the double-eyelid,the skin was sutured.Incision healing,eyelid swelling and complications were observed,and double-eyelid morphology was followed up.Six months after surgery,the patients’satisfaction with the surgical effect(satisfied,somewhat satisfied,dissatisfied)was investigated,and the upper eyelid scar status(including pigmentation,thickness,vascularity,and pliability)was scored using the Vancouver scar scale(VSS).The higher the score,the more serious the scar was.Results A total of 78 patients with single eyelid or subtle double eyelid were included,including 6 males and 72 females,aged 18-40 years old.All the patients underwent modified double-eyelid blepharoplasty through palpebral margin incision with preservation of the pretarsal orbicularis oculi muscle,29 patients underwent ptosis correction simultaneously,and 47 patients underwent epicanthus correction simultaneously.The incision healed by first intention after the operation.78 cases were followed up for 1 to 6 months,and slight upper eyelid swelling was eliminated in 71 cases at 10-15 days and in 7 cases at 25-30 days.Among them,61 cases were followed up for 6 months,the creases of double-eyelid was natural and smooth,bilateral basic symmetry,and there were no adverse manifestations such as double-eyelid shallowing and pretarsal tissue pilling,and no complications such as incompleted eye-closure.57 cases were satisfied with the results and 4 cases were somewhat satisfied.The incision scar was not obvious when the eyes were closed in 61 patients.The VSS score was close to 0,and the average score of pigmentation,thickness,vascularity,and pliability were 0.29,0,0.31 and 0 points,respectively.Conclusion This operation method preserves almost all the pretarsal orbicularis oculi muscle to promote the healling of lymph circulation.After the orbicularis oculi muscle is choosed for internal fixation,this more simple operation method can not only guarantee the efficacy of double-eyelid blepharoplasty through palpebral margin incision,but also accelerate the healling of the eyelid after surgery and reduce the incidence of incompleted eye-closure.