两种内眦赘皮矫正术联合重睑成形术构造开扇形与平扇形重睑的临床对比研究

A clinical comparative study of two kinds of epicanthoplasty combined with double eyelid surgery in the construction of inner and outer type double eyelids

目的探讨Z瓣成形术与倒L矫正术联合重睑成形术在不同重睑美学形态(开扇形和平扇形)下内眦赘皮矫正术式的选择。方法回顾性分析2021年11月至2022年10月南昌大学第一附属医院高新医院整形美容科收治的单睑伴内眦赘皮的患者临床资料。根据患者对内侧重睑美学形态要求分为开扇形组和平扇形组,2组患者都采用Z瓣成形术或倒L矫正术进行内眦赘皮矫正。术后随访观察2组患者的切口愈合及并发症发生情况、术后效果,收集2种术式术后12个月以上的矫正效果[无效、有效和显效,有效率=(显效例数+有效例数)/总例数×100%],术后瘢痕评分及患者满意度评分(分数越低表示瘢痕越轻、满意度越高)。对术后瘢痕评分及患者满意度评分比较采用独立样本t检验,对内眦赘皮矫正效果比较采用χ2检验,P<0.05表示差异有统计学意义。结果共纳入76例患者:开扇形组41例,男4例,女37例,平均年龄22.3岁(18~28岁),其中采用Z瓣成形术19例,倒L矫正术22例;平扇形组35例,男3例,女32例,平均年龄24.2岁(19~30岁),其中采用Z瓣成形术20例,倒L矫正术15例。术后随访12~16个月,平均14个月,2组患者的切口均一期愈合,未出现明显瘢痕增生及其他并发症情况,术后大多重睑形态自然,内眦赘皮矫正明显,均获得美学上的改善。Z瓣成形术与倒L矫正术的治疗有效率比较[94.87%(37/39)vs.94.59%(35/37)],差异无统计学意义(P>0.05)。开扇形组中倒L矫正术的术后瘢痕评分低于Z瓣成形术[(6.81±0.66)分vs.(7.31±0.88)分],满意度评分优于Z瓣成形术[(0.86±0.63)分vs.(1.73±0.65)分],差异均有统计学意义(P均<0.05)。平扇形组中倒L矫正术的瘢痕评分高于Z瓣成形术[(7.66±0.89)分vs.(7.00±0.64)分],满意度评分差于Z瓣成形术[(1.80±0.86)分vs.(1.00±0.56)分],差异均有统计学意义(P均<0.05)。结论内侧重睑美学形态要求为开扇形的患者,选择倒L矫正术能获得比Z瓣成形术更少的术后瘢痕和更高的术后满意度;要求为平扇形的患者,选择Z瓣成形术能获得比倒L矫正术更轻微的术后瘢痕和更高的术后满意度。

Objective To investigate the outcome of epicanthoplasty combined with double eyelidplasty in different aesthetic forms of double eyelids(inner type and outer type)using Z-epicanthoplasty and inverted L method.Methods The clinical data of patients with single eyelids and epicanthus were retrospectively analyzed from November 2021 to October 2022 in Gaoxin Hospital of the First Affiliated Hospital of Nanchang University.Patients were divided into inner type group and outer type group based on their aesthetic requirements for inner double eyelids.Both groups underwent Z-epicanthoplasty or inverted L method for epicanthus correction.Postoperative follow-up was conducted to observe the incision healing,complications,and postoperative effects of the two groups.The correction effects[ineffective,effective,and markedly effective,with the effective rate calculated as(the number of markedly effective cases+the number of effective cases)/total number of cases×100%],scar scores,and patient satisfaction scores were collected for more than 12 months after surgery.Independent sample t-test was used for the scar scores and patient satisfaction scores,and chi-square test was used for the epicanthus correction effects.P<0.05 indicated a statistically significant difference.Results A total of 76 patients were included.Among them,41 patients in the inner type group(4 males and 37 females,with an average age of 22.3 years,ranging from 18 to 28 years)underwent 19 cases of Z-epicanthoplasty and 22 cases of inverted L method;35 patients in the outer type group(3 males and 32 females,with an average age of 24.2 years,ranging from 19 to 30 years)underwent 20 cases of Z-epicanthoplasty and 15 cases of inverted L method.After 12 to 16 months of follow-up,with an average of 14 months,all incisions in both groups healed in the first stage,with no significant scar hyperplasia or other complications.Most of the double eyelid shapes are natural after the surgery,and the correction of epicanthus is obvious.Comparison of the treatment efficacy between Z-epicanthoplasty and inverted L method showed no significant difference[94.87%(37/39)vs.94.59%(35/37),P>0.05].In the inner type group,the postoperative scar score of the inverted L method was lower than that of the Z-epicanthoplasty[(6.81±0.66)vs.(7.31±0.88)],and the satisfaction score was better than that of the Z-epicanthoplasty[(0.86±0.63)vs.(1.73±0.65)],with statistically significant differences(both P<0.05).In the outer type group,the scar score of the inverted L method was higher than that of the Z-epicanthoplasty[(7.66±0.89)vs.(7.00±0.64)],and the satisfaction score was worse than that of the Z-epicanthoplasty[(1.80±0.86)vs.(1.00±0.56)],with statistically significant differences(both P<0.05).ConclusionFor patients requiring inner type aesthetic form of medial double eyelids,inverted L method can achieve less postoperative scars and higher postoperative satisfaction compared with Z-epicanthoplasty.For patients requiring"outer type"aesthetic form,Z-epicanthoplasty can achieve less postoperative scars and higher postoperative satisfaction compared with inverted L method.