适量去脂结合下睑腱膜加强眶前壁的眼袋整形术

传统的眼袋整形术为切除下睑松弛的皮肤和疝出眶缘的眶脂，达到去除眼袋的目的。但切除脂肪的量难于掌握，切除过量容易引起下睑凹陷，过少又容易使眼袋复发。为了解决这个问题，各学者提出了各种在去脂或不去脂的基础上进行加强前壁的术式，如：眶隔膜提紧术、眼轮匝肌切除或提紧     

改良Hamra法在东方人睑袋整复术中的应用

目的 探讨改良Hamra法在东方人睑袋整复中的手术效果.方法 在睑袋整复过程中,采用将打开的眶隔膜不予以缝合的方法.并回顾性分析了改良Hamra法对东方人睑袋整复手术疗效的影响.自2007年2月至2009年8月,采用改良Hamra法对40例下睑袋膨出伴泪槽畸形患者行整复术.结果 术后随访了其中的38例患者6个月至2年,结果显示:改良Hamra法不仅简化了手术操作过程,而且使眶隔脂肪分布均匀,能更有效地填充泪槽沟凹陷,效果满意;未出现明显的下睑退缩或外翻、下睑眶缘凹陷、出血及脸袋复发等现象.结论 改良Hamra法与Hamra法相比,在手术效果上无明显差异.但手术操作简单,组织创伤小,术后恢复快,尤其对眶区支持结构无明显影响,是矫正下睑皮肤松弛及中重度膨隆或伴泪槽畸形的睑袋症状简单而有效的方法.     

心脏涤纶补片联合睑板条悬吊矫正重度瘢痕性睑外翻的临床观察

目的：探讨应用心脏涤纶补片联合睑板条悬吊及皮瓣移植治疗重度瘢痕性睑外翻的临床效果。方法：选择2020年11月-2022年8月在笔者医院接受手术治疗的重度瘢痕性睑外翻患者5例（6眼）。术中将心脏涤纶补片置于睑板下缘与下眶缘之间，分离出下睑外侧睑板条并固定悬吊于外侧眶缘内上方的骨膜上。根据受区皮肤缺失范围采用游离皮片移植或临近皮瓣转移。术后观察并记录患者眼睑的位置、形态、功能及并发症发生率等情况。结果：术后随访11～15个月，5例患者重度瘢痕性睑外翻均完全矫正，眼睑形态位置恢复良好，开、闭眼功能正常，无植入物移位、脱出等并发症，随访期内无复发。结论：采用心脏涤纶补片植入联合睑板条悬吊及皮瓣移植术治疗重度瘢痕性睑外翻，术后眼睑形态改善良好，早期复发率低，为重度瘢痕性睑外翻治疗提供了新方法。     

＂加法理论＂在下睑袋整复术中的应用

目的：探讨改良传统下睑袋整形术式，摒弃传统眼袋术式中去除正常组织的方法，利用眼袋切口提升中面部，尽量达到术后自然，减少并发症的出现。方法：沿用传统的外切眼袋入路，眶隔浅层剥离，释放眶隔脂肪填充下眶缘沟，递进式提升眶区下垂软组织，保留眼轮匝肌折叠并固定，去除多余皮肤缝合切口，术后加压包扎24h。结果：95例术后回访基本满意，术后2例为二次眼袋手术的病例，双眼出现睑球分离现象，l例出现单侧睑球分离现象。分析原因为反复眼袋手术损伤后，眼轮匝肌瘢痕挛缩及下睑缘张力下降所致，重新按修复手术加固后壁防止粘连；外眦锚着术收紧下睑缘使其张力加强后均得到满意改善。结论：该术式尽量保留了正常组织不被去除，膨出的脂肪添加在凹陷的下眶缘沟处，提升后的眼轮匝肌被叠加利用，因此也称加法术式，术后外观自然效果明显；并发症减少，“递进”式中面部提升确保了提升效果，顾客满意度很高。     

分层策略性手术矫正下睑下至术后下睑退缩的疗效观察

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。     

下睑成形术术式选择:10年经验体会

目的 探讨适合中国人的下睑成形术术式选择标准.方法 自1998年至2008年,对2400例患者采用四种不同术式行下睑成形术,包括传统的经皮皮瓣法下睑成形术(n=862),经皮肌皮瓣法下睑成形术(n=738),经结膜下睑成形术(n=433),以及Hamra的眶隔重置技术(n=367).结果 本组2400例患者术均Ⅰ期愈合,925例患者获随访1个月至10年,95%患者对手术效果满意.并发症:下睑退缩20例,下睑外翻5例,下睑凹陷5例,干眼症2例.结论 经结膜入路下睑成形术是原发性睑袋患者的首选术式.经皮下睑成形术(皮瓣法或肌皮瓣法)适合于皮肤和肌肉松弛的患者.对于眼睑的支持结构(皮肤、肌肉和眶隔)松弛,或伴泪槽畸形的患者,应实施Hamra的眶隔重置技术.     

心脏涤纶补片在下睑肿瘤切除术中的应用

目的:探讨心脏涤纶补片在下睑肿瘤切除术中的应用。方法:对15例(15眼)下睑肿瘤的患者行肿瘤切除后,采用心脏涤纶补片代替缺损的睑板,利用眼周带蒂皮瓣转移修复缺损的眼睑前层,用下穹窿结膜移位修复缺损的睑结膜层。术后观察下睑缘的位置及植入的心脏涤纶补片是否有移位和脱出。结果:所有患者术后观察6~12个月,眼睑外观及功能均满意,下睑缘位于下角膜缘上约1mm,植入的心脏涤纶补片均无移位及脱出。结论:用心脏涤纶补片修复重建眼睑肿瘤切除后的眼睑缺损,安全可靠,为修复眼睑缺损提供了一种新材料。     

眶隔脂肪瓣矫正下眼睑眼袋合并泪沟及睑颊沟凹陷畸形的效果

目的探讨眶隔脂肪瓣矫正下眼睑眼袋合并泪沟及睑颊沟凹陷畸形的经验。方法 2020年2月至2021年5月, 中国医学科学院整形外科医院面颈部整形一中心用眼袋修复术联合眶隔脂肪释放术治疗35例眼袋合并泪沟及睑颊沟凹陷畸形患者, 男4例、女31例, 年龄35～63岁, 平均47.5岁。患者均存在不同程度下眼睑皮肤松弛、眶隔脂肪膨出、中重度泪沟和睑颊沟凹陷畸形及骨性眶缘轮廓感;均用经皮肤切口眼袋修复术, 将眶隔脂肪释放后向下牵拉并内固定于合适位置, 填充泪沟及睑颊沟。结果 35例患者手术伤口均一期愈合, 术后无血肿、感染, 切口愈合良好。术后随访时间3～18个月, 平均8.6个月。35例患者眼袋、泪沟及睑颊沟畸形明显改善。术后1个月内, 2例患者单侧仍然存在轻度脂肪膨出眼袋畸形, 2例患者术后早期出现轻度下睑外翻, 均未处理, 3个月后恢复。结论眼袋修复术联合眶隔脂肪释放的手术方式, 可有效修复下眼睑眼袋及矫正泪沟和睑颊沟凹陷畸形。     

睑袋形成原因分析及整复术式探讨

目的：探讨睑袋整复术眼睑年轻化的更好术式。方法：自2007年8月～2009年5月采用将眶隔脂肪回纳或移位,眶隔膜固定的方式行各种类型的睑袋整复术34例。结果：随访4～21个月,所有患者均对手术效果满意。下眼睑袋状外观完全消失,疝出的眶脂及下眶缘沟、眶鼻沟的凹陷得到明显矫正,恢复自然、圆钝的下眼睑轮廓;外眼角及下睑缘形状自然;无术后复发、下眼睑凹陷等并发症。结论：将眶隔脂肪回纳或移位,眶隔膜固定的方式行睑袋整复术是从解剖学的角度矫正睑袋形成的原因,疗效更为满意。     

下睑眼袋整复术若干问题分析讨论（附40例报告）

下睑眼袋整复术，是眼睑整形中较常见的手术之一。本文４０例眼袋整复术的临床实践，对眼袋形成、临床分型、术式选择及术后并发症的防治进行了讨论分析。     

Reconstruction of the levator function and conjunctiva using an inferiorly based orbital septal flap for subtotal full-thickness defects of the upper eyelid: two cases of ocular sebaceous carcinoma

Without using the lower eyelid, functional reconstruction of the tarsoconjunctival layer is challenging for subtotal full-thickness defects of the upper eyelid. In 2 cases of ocular sebaceous carcinoma, the levator function and conjunctiva were reconstructed using the inferiorly based orbital septal flap and conchal cartilage graft. The raw surface of the orbital septal flap was epithelialized within 14 days postoperatively. The new upper eyelid with a stable lid margin could open and close properly. Our surgical procedures may be available in the case that the lower eyelid is not usable.     

眶隔脂肪异位游离移植矫正眶鼻沟凹陷的睑袋美容手术

目的 探讨一种用切除的眶隔脂肪异位游离移植以矫正眶鼻沟凹陷的睑袋美容方法 .方法 在眼轮匝肌与眶隔间分离,于眶下缘打开眶隔,去除多余的眶隔脂肪,折叠加强眶隔后,将去除的眶隔内脂肪重新回填于眶隔外,用于修复眶鼻沟的凹陷畸形.自2007年3月至2009年2月,用此术式共诊治睑袋患者135例.结果 本组患者共135例,获随访1～12个月,术后异位游离移植的脂肪存活率高,下睑外形饱满,眶鼻沟存在的凹陷有明显改善.结论 本方法 是一种矫治睑袋的有效方法 ,适用范围较广,尤其适用于伴有下眶缘眶鼻沟凹陷的睑袋患者.     

Evolution of lower lid support following lower lid/midface rejuvenation: the pretarsal orbicularis lateral canthopexy.

An 18-month experience with an endoscopically assisted "closed" technique of modified transblepharoplasty lower lid and midface rejuvenation is presented. In the modified approach, preseptal dissection in the body of the lower lid is eliminated to decrease the incidence of septal scarring and lower lid retraction. The technique also leaves intact the connection between the orbicularis and septum, resulting in tightening of the septum and better support of lid with redraping of the muscle. By providing more secure support of the lower lid and lateral canthus, the need for direct canthal manipulation has been reduced significantly. This experience confirms, however, that an occasional patient with significant exophthalmus occasionally might need additional lower lid support (spacer graft or more direct lateral tendon fixation) to obtain ideal lower lid position. Conversely, an occasional older patient with relative enophthalmus and horizontal lower lid laxity will be best served by canthoplasty with correction of excess laxity. So far, the quality of aesthetic results compared with the "open" approach has not been compromised, and morbidity seems to have been decreased.     

Replacement of portal vein with E-PTFE vascular graft; experimental study on process of the endothelialization

Expanded polytetrafluoroethylene (E-PTFE) vascular graft was been exposed to intestinal content and evaluated the process of endothelialization and as to whether or not the material was feasible for its use under condition similar to clinical pancreatic surgery. In group A, E-PTFE tubular graft was inserted into the portal vein defect. In group B, choledochojejunostomy was also performed combined with the E-PTFE graft interposition. In other groups, bile (group C) or suspension of Escherichia Coli (group D) was put on graft implanted in the portal vein. The grafts were removed from the dogs for histological and scanning electronmicroscopic evaluation at intervals varying from 12 hours to 4 years and 8 months after surgery. Thirty one of 38 grafts were patent (patency rate; 82%). Complete formation of the inner capsule of the graft was essential to endothelialization. Direct extension of the endothelium was seen from the anastomotic site. Sporadic endothelialization was observed, however, communications among islet formed endothelialized portions. It were remarkable and endothelium derived from the host vein. These results demonstrated the feasibleness of clinical application of the E-PTFE graft to portal vein reconstruction with combination of the digestive surgery.     

Late occlusion at the anastomosis site of an extended polytetrafluoroethylene (E-PTFE) graft with small caliber

Recently expanded polytetrafluoroethylene (E-PTFE) graft is often used in arterial bypass for atherosclerosis obliterans. In our series of 38 patients (48 legs) undergoing femoropopliteal bypass with E-PTFE graft of 6mm-caliber, a cumulative patency rate was 40.8% at 36 months after operation and a mean duration of patency was 26.3 months. To clarify the cause of occlusion, the diseased grafts were removed and histopathologically examined. Macroscopically, the E-PTFE graft was occluded by the intimal hyperplasia, so called pannus ingrowth from the recipient artery into the graft. The pannus formation of the graft was more remarkable in the distal than in the proximal site of anastomosis, suggesting the influence of blood flow on its formation. Microscopically, no endothelial cells were observed inside the E-PTFE graft except for the surface of pannus. Thus, less extension of endothelialization was thought to be a cause of late occlusion in E-PTFE grafts. Most desirable is the autologous saphenous vein for femoropopliteal bypass. However, when it is not available, E-PTFE graft with a larger caliber must be used in combination with postoperative anticoagulant therapy.     

Experimental and clinical studies on prevention of vascular prosthetic infection

Since the treatment of infected vascular prosthetic graft is difficult, it is important to prevent graft infection. At the operation of aneurysmectomy, a part of aneurysmal wall was cultured. As a result, bacterial growth could be seen in 21 out of 58 cases (36%). In this experiment, expanded polytetrafluoroethylene (E-PTFE) graft was soaked in a solution of tobramycin (TOB) and tested for the prevention of graft infection. First, this E-PTFE graft with a TOB solution was tested for antithrombogenicity and patency rate, and secondly its effect of preventing graft infection was evaluated. 1. TOB had an effect of antithrombogenicity. 2. Patency rates of the E-PTFE graft with a TOB solution were as good as those of the graft soaked in a saline solution. 3. TOB concentration in the grafts was more than 100 micrograms/g after 6 hours from the implantation and more than MIC after 24 hours. 4. E-PTFE graft with a TOB solution had an effect of antibacteria. This study suggested that E-PTFE graft soaked in a TOB solution was effective to prevent graft infection.     

颞肌筋膜瓣与全厚皮片移植修复下睑凹陷性畸形

目的 探讨颞筋膜瓣或颞肌筋膜瓣与自体全厚皮片移植，在下睑凹陷性瘢痕畸形修复中的应用效果。方法 设计以颞浅动脉为蒂的颞筋膜瓣，对伴眶下壁骨缺损者同时行以颞浅、深动脉为蒂的颞肌筋膜瓣，并取耳后全厚皮片移植联合矫正下睑凹陷性畸形。结果 8例患者，术后组织瓣及皮片成活良好，凹陷处填充效果满意。随访6个月至1年，睑外翻矫正，瘢痕不显，颞部供区毛发生长良好。结论 应用颞筋膜瓣或颞肌筋膜瓣与全厚皮片移植，联合矫正下睑凹陷性畸形的方法，具有操作简便。且无明显的供区损害的特点，是修复下睑凹陷性瘢痕畸形较理想的方法。     

Lower eyelid examination following blepharoplasty in the monkey

To determine the validity and reliability of the physical examination in evaluating abnormalities of the lower eyelid following blepharoplasty, a model using monkeys was developed. One plastic surgeon performed a variety of blepharoplasties, including extensive resection of lower lid skin and/or muscle, and/or the creation of scarring in the orbital septum. Three months postoperatively, a second plastic surgeon and an ophthalmologist examined these monkeys' lower eyelids. Although there was substantial agreement between the observers as to the degree of scleral show and which eye was "worse" in each monkey, the examiners were correct in just 7 of 24 attempts to identify the exact operative procedure that had been performed. This study demonstrates that it is difficult to identify the cause of abnormalities in appearance and position of the lower lid after blepharoplasty. Orbital septal scarring can cause the same degree of scleral show as excessive skin resection. Muscle resection contributed little to lower lid position.     

三步法睑袋整形术矫正泪槽和睑颊沟的临床应用

目的探讨一种矫正泪槽和睑颊沟的睑袋整形术的方法及疗效。方法对36例睑袋伴有泪槽和睑颊沟畸形者采用三步法睑袋整形术,包括保留完整的眼轮匝肌眶隔脂肪切除术、选择性释放眼轮匝肌支持韧带、去除多余的皮肤。结果本组共36例患者,术后均得到眶下区年轻化改善。随访3～18个月,下睑缘形态自然,无眼睑外翻发生,切口瘢痕隐蔽,患者对外观效果满意。结论采用三步法睑袋整形术对矫正伴有泪槽和睑颊沟畸形的患者,疗效确切,不良反应少,可恢复眶区年轻化效果,值得临床推广应用。     

保留眶膈脂肪及真皮眼轮匝肌复合组织悬吊的下睑袋整形术

目的 介绍睑袋整形术的一种新方法和预防术后下睑外翻的有效措施。方法剪开松弛的眶膈，释放出眶膈脂肪，将其充填于眶骨前方，消除深陷的睑－颊沟。在切除切口缘多余的皮肤时，应用“需切除的组织最后切除”和“要善于预测、控制和减少张力”两项基本原则，以避免皮肤发生下睑外翻。结果 共为８例（１６只眼睛）施行手术，术后所有患者下睑形态良好，效果满意。结论 眶膈脂肪释放、保留的下睑袋整形术，是一种操作简单、设计更为