儿童睑板腺囊肿合并感染168例手术及超短波治疗

目的探讨手术及超短波治疗合并感染的儿童睑板腺囊肿临床疗效。方法对168例40d~6岁的睑板腺囊肿合并感染患儿行手术治疗及术后超短波理疗,并进行追踪观察及统计分析。结果局部硬结消失为治愈。153例术后恢复良好,局部包块消失,眼睑平坦,无明显瘢痕。15例局部包块消失,眼睑微量瘢痕组织,无红肿。经过半年随访,4例复发。结论儿童睑板腺囊肿并感染保守治疗效果差,手术治疗及术后超短波理疗安全有效。     

睑板夹辅助杆的设计及临床应用

目的:观察睑板夹辅助杆在睑板腺囊肿切除术中的应用。方法:前瞻性病例对照研究。将2019年1月至12月安阳市眼科医院行睑板腺囊肿切除术80例(80眼)随机分为两组：A组40例,术中使用作者设计的睑板夹辅助杆帮助固定睑板腺夹;B组40例,术中单纯使用睑板腺夹。术后3个月随访。比较两组手术耗时、治愈率及复发率。结果:A组手术...     

改良的睑板腺囊肿刮除术

传统的睑板腺囊肿刮除术 ,效果很好。但是在剪除囊壁时对周围正常组织损伤相对较大。因此 ,我们在临床工作中 ,对手术方法进行了一点改良。于 1999年 6月～ 2 0 0 1年 3月对 87例睑板腺囊肿患者施行了改良的睑板腺囊肿刮除术 ,收到良好效果。现报告如下 :一般资料本组 87例 ,男 5 2例 ;女 ,3 5例。上睑 61例 ,下睑 2 6例。年龄 8～ 47岁 ,平均 2 3 5岁。睑板腺囊肿小如黄豆 ,大如樱桃。方　法1.在局麻下用睑板腺囊肿镊挟住睑板腺囊肿部位的眼睑。在睑结膜面垂直于睑缘切开囊肿 ,切口大小约 3ｍｍ。2 用锐利的刮匙尽量地将囊肿内容物及囊壁…     

泪道冲洗针头联合睑板腺夹在内眦部局限性睑缘色素痣切除术中的应用效果

目的 探讨泪道冲洗针头联合睑板腺夹在内眦部局限性睑缘色素痣切除术中的应用效果。设计回顾性非比较性病例系列。研究对象2017-2021年北京同仁医院眼科诊为内眦部局限性睑缘色素痣患者16例(16眼)。方法 回顾患者的病历资料。所有患者显微镜下手术切除睑缘色素痣。利用睑板腺夹固定睑缘部位色素痣,借助插入泪道中的泪道冲洗针头观察泪道的位置及其与色素痣的毗邻关系,结膜面缺损旷置,眼睑前层缺损局部皮瓣修复。主要指标术后泪道情况,眼睑位置及外观。结果 术后平均随访(8±1.5)个月。16例患者术中视野均清晰,出血量少。最后复查时均无溢泪,冲洗下泪道均通畅。无明显瘢痕、成角畸形、眼睑内外翻、泪小点闭锁,睑缘色素痣无复发。结论 内眦部局限性睑缘色素痣切除术中使用泪道冲洗针头及睑板腺夹术中视野清晰且止血效果好,同时可保护泪道避免损伤。(眼科,2022,31:312-314)     

眼睑全层裂伤89例临床处理体会

目的 探讨眼睑全层裂伤临床处理经验,减少术后并发症.方法 手术修复89例眼睑全层裂伤.结果 89例均一期愈合,术后并发睑缘畸形5例,瘢痕性睑外翻3例,溢泪7例.结论 根据不同的外伤情况,采取针对性的手术方案和正确细致的手术操作是减少术后并发症的关键.     

异体巩膜联合生物羊膜移植修复眼睑全层大缺损临床观察

目的 探讨异体巩膜联合生物羊膜移植替代睑板修复眼睑全层大缺损的远期效果.方法 对39例因肿瘤切除术或外伤造成的眼睑全层大缺损(超过睑长四分之一时)患者行异体巩膜联合羊膜移植替代睑板的眼睑重建术,并随访观察半年至5年.结果 39例患者经眼睑重建术后,植片生长良好,功能正常,对眼球无刺激,对视功能无影响,肿瘤未见复发.结论 异体巩膜联合生物羊膜移植替代睑板修复眼睑全层大缺损远期疗效确切,术后眼睑形态、功能恢复良好,不影响视功能,是一种较为理想的手术方式.     

部分睑板结膜全层切除术治疗轻度上睑下垂

目的 探讨部分睑板结膜全层切除术治疗轻度上睑下垂的方法和效果。方法 20例轻度上睑下垂，经皮肤入路，根据术前测量计算结果，行部分睑板结膜全层切除术。结果 20例术后均有轻度眼睑闭合不全，其中15例术后1月眼睑闭合正常，5例术后3月眼睑闭合正常。随访6～18月均无上睑下垂复发，无其他并发症发生，效果满意。结论 部分睑板结膜全层切除术治疗轻度上睑下垂设计简单；术中暴露清楚，操作方便；术后恢复快、效果确切。     

60例眼睑全层裂伤的临床特征和急诊手术方法

目的探讨急诊眼睑全层裂伤的病因、临床特点、手术方法及效果。设计回顾性病例系列。研究对象北京同仁医院眼科急诊的60例（60眼）眼睑全层裂伤患者。方法询问病史，详细眼科检查。应用垂直褥式、水平褥式和三缝线缝合法修复眼睑全层裂伤。对伴有泪小管断裂、内外眦韧带离断、眼睑皮肤缺损、眼睑全层缺损、提上睑肌断裂者，还需行泪小管断裂吻合、内外眦韧带复位、提上睑肌断裂缝合复位、皮肤缺损及眼睑缺损修复术。主要指标眼睑形态，日艮睑位置，眼睑运动功能，吻合后的泪小管是否通畅。结果眼睑全层裂伤病因主要是车祸伤、外物击伤、坠落伤、动物咬伤。眼睑裂伤多伴有泪小管断裂、内外眦韧带离断、眼睑皮肤及全层缺损、提上睑肌断裂。急诊手术后随访6～12个月，绝大部分患者术后眼睑外观形态、眼睑闭合以及运动恢复良好，38例（95％）泪小管吻合术后保持通畅。结论车祸伤和外物击伤是急诊眼睑全层裂伤的主要原因，及时、正确、细致地手术处理可使大部分眼睑裂伤在Ⅰ期得到良好的修复，同时也为少部分患者Ⅱ期整复做好准备。     

石碳酸辅助治疗睑板腺囊肿的临床观察

目的:为提高睑板腺囊肿手术的成功率,探讨减少睑板腺囊肿复发的简易手术方法。方法:对950例睑板腺囊肿采用石碳酸涂睑板腺囊肿的囊壁,观察其疗效。结果:950例睑板腺囊肿均能达到破坏其囊壁的完整性,术后随访7d~6mo,无复发,达到根治目的。结论:石碳酸治疗睑板腺囊肿方法简易、并发症少,是较为理想的手术方法。     

异种脱细胞真皮基质联合邻位皮瓣修复眼睑全层缺损的临床观察

目的 观察异种脱细胞真皮基质联合邻位皮瓣Ⅰ期修复眼睑恶性肿瘤切除术后眼睑全层缺损的临床疗效.万法 35例(35眼)眼睑恶性肿瘤患者,其中基底细胞癌21例,睑板腺癌13例,鳞状细胞癌1例;累及上睑者12例,累及下睑者23例.所有患者均行术中冰冻并根据冰冻结果确定切缘,肿物切除后眼睑有不同程度全层缺损.取异种脱细胞真皮基质替代结膜睑板组织,根据皮肤缺损大小做邻近滑行或转位皮瓣修补眼睑缺损.术后观察皮瓣及口腔修复膜愈合情况、有无眼睑闭合不全及睑球粘连.结果 随诊半年,异种脱细胞真皮基质已完全溶解,被爬行结膜上皮覆盖,皮瓣愈合良好、无一例皮瓣坏死.其中28例患者术后恢复良好,无眼睑闭合不全及睑内、外翻.4例患者出现轻度眼睑闭合不全,均无暴露性角膜炎.3例患者出现轻度睑球粘连.结论 异种脱细胞真皮基质可替代睑板结膜组织,联合邻位皮瓣治疗眼睑恶性肿瘤切除术后的眼睑全层缺损有较好的临床疗效,可减少患者因取口唇黏膜或行二次眼睑重建的痛苦.     

Sebaceous and meibomian carcinomas of the eyelid. Recognition, diagnosis, and management

Sebaceous carcinoma of the eyelid is frequently misdiagnosed clinically and histopathologically. The tumor may present as a lid mass, recurrent chalazion, or diffuse unilateral blepharoconjunctivitis. Fifty percent of cases are misdiagnosed, often by an inexperienced general pathologist interpreting the initial biopsy. Frozen-section monitoring of surgical margins has been reported unreliable in 25% of cases. Mohs surgery is also unreliable in cases where there is pagetoid intraepithelial spread or skip lesions. This tumor may spread regionally into the lacrimal secretory and excretory systems, to regional lymph nodes, and rarely disseminate hematogenously. Guidelines for management are discussed.     

表浅肌肉腱膜皮瓣联合硬腭黏膜移植修复全层眼睑缺损

目的探讨利用眼周表浅肌肉腱膜系统（SMAS）皮瓣联合硬腭黏膜移植修复中、重度全层眼睑缺损的临床疗效。方法对26例（26只眼）大于或等于眼睑全长1／2的全层眼睑缺损患者,采用硬腭黏膜移植替代眼睑后层,即睑板和睑结膜层;利用眼周血供丰富的SMAS皮瓣修复眼睑前层,即皮肤肌肉层。其中5例采用眼轮匝肌蒂皮瓣,5例为颞浅动脉皮瓣,7例为眉上皮瓣,9例为上睑皮肤轮匝肌双蒂瓣。手术操作中首先行硬腭黏膜移植,然后根据眼睑前层缺损的部位和范围设计眼周的SMAS转位皮瓣,术毕行睑缘缝合3个月。结果全部患者随访6～36个月,平均11个月。转位皮瓣全部成活,硬腭黏膜植片成活好,无收缩,眼睑外观及功能改善较满意。结论眼周SMAS皮瓣联合硬腭黏膜移植可一次性修复缺损的眼睑全层,效果肯定。     

自体硬腭黏膜移植联合眶周皮瓣修复全层眼睑缺损

目的：评价眼睑恶性肿瘤切除术后采用自体硬腭黏膜移植联合眶周皮瓣进行眼睑再造的临床效果。 方法：患者10例10眼行眼睑恶性肿瘤切除术后重度眼睑缺损,采用硬腭黏膜移植替代眼睑后层,即睑板和睑结膜层,利用眶周皮瓣修复眼睑前层。 结果：术后随访6~12mo,眼睑外观及功能基本恢复正常。硬腭黏膜移植片及转移皮瓣全部成活,无感染、移位、挛缩。 结论：自体硬腭黏膜移植联合眶周皮瓣转移修复全层眼睑缺损,效果肯定。     

Meibomian gland adenocarcinoma with regional lymph node metastasis

Meibomian gland carcinoma of the eyelid is a common neoplasm which clinically simulates a benign condition of chalazion. Although growing slowly, metastasis to regional lymph nodes is frequent, at a rate of 17-28% in this country. Eleven (11) cases of Meibomian gland carcinoma with regional lymph node metastasis are reported, and the therapeutic modalities have been tailored to suit the individual cases, including full-thickness local excision, orbital exenteration, radical cervical dissection, and superficial parotidectomy.     

硬腭黏膜移植联合眼周皮瓣修复下睑全层缺损

目的:探讨用硬腭黏膜植片修复眼睑缺损后层,眼周皮瓣修复眼睑前层缺损,这一联合手术的临床效果。方法:对8例因下睑肿瘤切除所致的下睑全层缺损,采用自体硬腭黏膜移植联合眼周皮瓣重建下睑。结果:随访8mo以上,全部病例硬腭黏膜植片及转移皮瓣全部成活,除1例下睑轻度退缩外,眼睑外观和功能满意,获得良好效果。结论:硬腭黏膜移植联合眼周皮瓣修复下睑全层缺损,可以一次性修复缺损的皮肤、睑板、结膜,效果肯定,具有较高的临床价值。     

Full-thickness lid sutures for entropion

Insertion of full-thickness absorbable eyelid sutures was carried out during a four-year period on 34 unselected patients with spastic or senile entropion. Four 5/0 Dexon sutures proved to be the most effective method. The over-all success rate was 50% and thus the operation cannot be recommended as the standard procedure for cases of entropion. Even so, it is useful in cases of spastic entropion due to surgery or corneal ulceration, when 100% success can be expected, and also when minimal surgical trauma or inconvenience is desired for often very elderly patients.     

Eyelid splitting with follicular extirpation using a monopolar cautery for the treatment of trichiasis and distichiasis

PURPOSE: To assess the efficacy of eyelid splitting coupled with follicular extirpation via monopolar cautery in the treatment of trichiasis and distichiasis. METHODS: Between March 2000 and October 2003, this surgery was performed on 52 eyelids from 45 patients, with a mean follow-up period of 14.3 months (ranging from 12.3 to 17.6 months) . Under local anesthesia and a surgical microscope, a chalazion clamp is positioned on the eyelid, and a no. 11 scalpel is employed to make an incision located immediately anterior and parallel to the abnormal eyelash line. Each of the abnormal hair follicles is then removed via cautery with a monopolar needle. No sutures are involved in this procedure. RESULTS: Forty-four eyelids of 40 patients (84.6%) were successfully treated without recurrence or any residual symptoms. Repeat surgery was then performed on eight eyelids, with successful results in six cases. The cumulative success rate for this procedure was 96.1%. No complications were noted in the treated area, including lid deformities, granuloma formation, infections, and others. CONCLUSIONS: Eyelid splitting coupled with follicular extirpation via cautery with a monopolar needle, a procedure which requires no sutures, constitutes a simple and effective method for the treatment of both trichiasis and distichiasis and is associated with favorable functional and cosmetic results.     

Sebaceous carcinoma of the eyelid: pitfalls in diagnosis

Sebaceous carcinoma of the eyelid and adnexa commonly simulates other entities both clinically and pathologically. Between 1905 and 1981, 43 patients with sebaceous carcinoma of the eyelid were seen at the Mayo Clinic. Prior to establishing the diagnosis of sebaceous carcinoma, patients commonly carried multiple clinical diagnoses (mean = 2.2) and multiple microscopic diagnosis (mean = 1.7). The most common clinical diagnosis was chalazion. The patients' average age at the onset of symptoms was 61.5, with females predominating. The upper eyelid was most commonly involved. The conjunctival surface was involved alone in a statistically greater number of patients with metastatic disease (P less than 0.05). Second primary malignancies and/or radiation exposure was found in 11 patients, or 25% of our series. Of the second primary malignancies, malignancies of the skin and breast were most common. Sebaceous carcinoma should be suspect in atypical presentations of common disorders and in cases in which clinical and pathologic findings are not well correlated. If sebaceous carcinoma of the eyelid is a diagnostic consideration, we recommend a frozen section with fat stain together with a full-thickness lid biopsy. Surveillance for second primary malignancies may be warranted.     

Free tarsal graft combined with skin transposition flap for full-thickness lower eyelid reconstruction

We present the surgical outcome in a series of 4 patients with large full-thickness eyelid defects after basal cell carcinoma excision. The patients underwent reconstructive eyelid surgery using autogenous free tarsal grafts combined with a skin transposition flap from the upper eyelid. Two female and 2 male patients ranging in age from 44 years to 85 years were treated. In all 4 cases, posterior lamellae were reconstructed using a free tarsal graft, and the outer lamella was developed with a transposition skin flap from the upper eyelid. The skin flap provided adequate vascular support in all cases. Follow up of 10 months to 20 months showed a good outcome in all patients. Reconstruction of full thickness eyelid defects after extensive tumor excision requires reforming of the anterior and posterior lamella. Whereas the Hughes or Cutler Beard techniques for eyelid reconstruction require a 2-step approach with occlusion of the eye for at least 1 week, reconstruction with a free tarsal graft is a 1-stage procedure and does not entail eye occlusion. Autogenous tarsus as a free graft proves to be a simple procedure for posterior lamella substitution in lower eyelid surgery, especially in combination with a skin transposition flap from the upper eyelid.