摘要
目的探索下睑下至术后下睑退缩的手术矫治方法及疗效。方法对27例下睑下至术后下睑退缩的病例(54侧)追溯原手术入路方式,结膜入路,共9例,占33.33%;皮肤入路共9例,占33.33%;双入路,同时行结膜入路与皮肤入路者,共9例,占33.33%。根据入路方式及临床表现,初步判断下睑前层、中层、后层退缩情况。手术均采用皮肤入路,拆除中层及后层固定缝线,采用Hamra释放弓状缘和保留眶脂肪的下睑成形术,松解眶隔及眶脂肪层的瘢痕挛缩,采用横切纵缝法恢复中层及后层弹性及解剖位置。对于前层的缺损和不足,采用悬吊眼轮匝肌及提升中面部皮肤加以补充。结果27例术后随访2~36个月,平均13.1个月。所有患者的下睑退缩均得到明显矫正,满意率达93.5%。结论下睑下至导致的轻中度下睑退缩,拆除缝线,松解瘢痕粘连后复位良好,结合Hamra下睑成形术及眼轮匝肌悬吊术,可实现良好的矫治效果。
Objective To explore the curative effect of stratified strategic operation for correction of postoperative lower eyelid retraction in patients underwent lowering the lower eyelid.Methods The original surgical approaches were traced in 16 cases(32 eyes)with lower eyelid retraction after lowering the lower eyelid:3 cases(6 eyes)with transconjunctival approach,accounting for 18.7%;9 cases(18 eyes)with transcutaneous approach,accounting for 56.3%;4 cases with transconjunctival combined skin approach,accounting for 25.7%.According to the approach and clinical manifestations,the retraction of the anterior,middle and posterior layers of the lower eyelid was preliminarily judged.The skin approach was used in all operations,removing the sutures in the middle and posterior layers.And adopting Hamra lower eyelid blepharoplasty with releasing arcuate margin and preserving orbital fat,to release scar contracture of orbital septum and orbital fat layer,and the middle and posterior elasticity and anatomical position were recovered.For the defects and deficiencies of the anterior layer,the suspension of orbicularis oculi muscle and the lifting of the midfacial skin were used to supplement.Results All 16 cases(32 eyes)were followed up for 2-36 months,with an average of 13.1 months.All cases were significantly corrected and improved,and the satisfaction rate was 93.5%.Conclusion For the mild to moderate lower eyelid retraction caused by lowering the lower eyelid,suture removal,release of scar adhesion and good reduction can be achieved,combined with Hamra lower blepharoplasty and orbicularis oculi muscle suspension,good correction results can be achieved.
作者
聂丽丽
鲁华
郭美利
赵红雁
闫飞
孙辉
NIE Lili;LU Hua;GUO Meili;ZHAO Hongyan;YAN Fei;SUN Hui(Department of Plastic Surgery,Henan Plastic and Cosmetic Hospital,Zhengzhou 450000,China;Department of Plastic and Aesthetic Surgery,Shenzhen People’s Hospital(The First Affiliated Hospital,Southern University of Science and Technology,The Second Clinical Medical College,Jinan University),Shenzhen 518020,China)
出处
《组织工程与重建外科》
CAS
2023年第5期471-475,共5页
Journal of Tissue Engineering and Reconstructive Surgery
关键词
睑袋整复术
下睑退缩
下睑复位测量
Lower eyelid blepharoplasty
Lower eyelid retraction
Lower eyelid reduction measurement
