组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (5): 471-.

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分层策略性手术矫正下睑下至术后下睑退缩的疗效观察

  

  • 出版日期:2023-10-09 发布日期:2023-11-01

Observation on the curative effect of stratified strategic operation for correction of lower eyelid retraction caused by lowering the lower eyelid

  • Online:2023-10-09 Published:2023-11-01

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。

关键词:

Abstract:

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.

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