外眦韧带及骨膜修复眼睑缺损的临床观察

目的 观察眼睑肿瘤切除术后以外眦韧带及骨膜组织Ⅰ期修复眼睑缺损的效果。方法 33列发睑肿瘤切除行Ⅰ期眼睑缺损修补术，在显微镜下用尖刀片彻底切除眼睑癌组织，潜行分离颞侧皮肤、肌层、外眦韧带及骨膜，视缺损大小松解外眦带及骨膜，内眦睑残端与外眦韧带及骨膜组织缝合。观察术后外观及眼睑功能，术后随6月－3年。结果 在33例中，上睑肿瘤21例，下睑12例，术后7天拆线，31例治愈（93．94％），外观及功能满意。2例显铲。结论 外眦韧带及骨膜转位方便，且外眦韧带及骨膜为转位活组织，无术后坏死或组织挛缩，可对眼睑肿瘤术后的眼睑缺损行I期修复。     

提上睑肌缩短术治疗重度先天性上睑下垂的疗效观察

目的探讨提上睑肌缩短术治疗重度上睑下垂的临床疗效。方法对19例(26只眼)重度上睑下垂患者采用皮肤-睑结膜入路提上睑肌缩短徙前术。对其手术效果、适应证、缩短量及手术技巧进行总结。结果19例(26只眼)术后眼睑弧度及双重睑形成良好,睑裂高度正常。结论提上睑肌缩短术治疗重度上睑下垂既能恢复眼睑生理功能,又能达到改善美容的效果。     

眼睑松弛症的手术治疗分析

目的:探讨眼睑松弛症的手术治疗方法及效果。方法:对15例26眼眼睑松弛症患者均在停止发作并静止6mo以上手术。对于上睑皮肤松弛、上睑下垂、泪腺脱垂和睑裂横径缩短均采用重睑切口,上睑下垂视提上睑肌腱膜有无断裂采取提上睑肌腱膜修复或折叠术。泪腺脱垂全层缝合泪腺组织固定于眶泪腺窝处的骨膜上。睑裂横径缩短将外眦韧带缝合固定于外侧眶缘骨膜,下睑内翻做平行于睑缘的皮肤切口,去除多余皮肤及部分眼轮匝肌。结果:15例患者皮肤松弛得到明显改善,其中上睑下垂、睑裂横径缩短和下睑内翻,也均得到满意矫正,泪腺脱垂1例明显改善,余复位良好。随访6mo～2a,无复发。结论:手术治疗安全,效果确切。     

眼睑皮肤松弛症及其伴发畸形的手术整复

目的 评价眼睑皮肤松弛症及其伴发畸形的手术整复效果.设计 回顾性病例系列.研究对象 35例(52眼)眼睑皮肤松弛症稳定期患者.方法 所有患者实施上睑畸形矫正术,做上睑重睑切口,切除多余松弛皮肤及眶脂肪,18例(36眼)联合行泪腺脱垂复位术;10例(16眼)联合上睑下垂矫正术.4例(6眼)行下睑缩矫正术.7例(14眼)行外眦畸形矫正术,联合或二期行眼睑皮肤松弛矫正或上睑下垂矫正术.主要指标 双眼重睑形态,眼睑位置,眼睑运动功能,泪腺的位置,有无泪液分泌异常.结果 随访6～60个月,所有患者双眼上睑重睑基本对称,双上睑形态良好,眦角位置接近正常,无溢泪及干眼症状.2例(3眼)患者于术后29及36个月复诊时发现泪腺脱垂复发,再次行泪腺脱垂复位术,术后分别随访18、24个月,未发现泪腺再脱垂.结论 采用眼部整复手术矫正眼睑皮肤松弛症及伴发畸形安全有效,术后复发率较低.     

自体眶骨膜替代睑板植入修复外眦部眼睑缺损

目的观察自体眶骨膜修复眼外眦部眼睑缺损的临床效果。方法采用自体眶骨膜替代睑板联合滑行结膜瓣和眶周旋转滑行皮瓣修复外眦部眼睑缺损。共6例（6只眼）,术后随访6个月至3年。结果术后眼睑形态及功能满意,无收缩性上睑内卷,睑内外翻,植入骨膜瓣无吸收、移位及感染。结论自体眶骨膜替代睑板植入修复外眦部眼睑缺损简便易行,术后并发症少。自体眶骨膜是理想的睑板替代物。     

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。     

浅析上睑下垂术中睑球分离发生原因及处理方法

目的 探讨上睑下垂术中发生睑球分离的原因及处理方法.方法 通过提上睑肌缩短术和额肌瓣悬吊术治疗268例(339只眼)上睑下垂,术中发生15例(17只眼)脸球分离分析原凶后,行额肌瓣隧道式穿过眶隔、调整肌瓣-睑板吻合点的位置、内外眦韧带固定、外眦部睑板楔形切除、弹力绷带加压包扎等方法处理.结果 所有病例睑球分离均获得矫正,随访1～2年,睑球分离无复发.矫正效果满意.结论 对于上睑下垂术中发生睑球分离,通过术中矫正可以改变眼睑的位置,获得满意效果.     

先天性眼睑综合征眼睑成形术及其改良(摘要)

先天性眼睑综合征(Komoto Syndrome)包括倒向性内眦赘皮、小睑裂、上睑下垂及内眦间距过宽。近年来我们收治了9例(18眼),手术方法及改良术式如下. 一、睑裂开大术:有单纯性外眦切开及Blascovis外眦角成形术两种.延长上睑长度上睑缘弧度形成自然,术后睑裂开大增宽。二、内眦部成形术:改良Blair氏法作内眦部成形,即对偶三角皮瓣交叉加L形皮肤切除,减轻皮肤纵向的紧张度,消除内眦赘皮皱折。三、缩短内眦间距:采用内眦韧带折叠缩短术,经折叠环及鼻背部皮下深层的矩形缝线     

眉区除皱与下睑袋整复一期完成矫正眼部区域衰老综合征

众所周知 ,面部衰老是先从眼部开始的。眼部衰老包括眉部组织下垂、上睑皮肤松驰、变薄 ,使上睑皮肤的中后方皮纹斜向外下方走行 ,鱼尾纹呈放射状向外上方走行 ,形成外眦部从上睑到颞部的“对号”形皱纹以及伴随不同程度的下睑皮肤、肌肉松驰、下睑袋。本文将以上眼部区域形成的衰老征象称为衰老综合征 (aged syndrom e)。以往的矫正方法 ,多以消除下睑袋为主 [1 ] ,而对上睑松驰不作调整 ,结果术后外眦部尚留有冒缘状遮盖 ,极不协调 ,达不到整体矫正的效果。自 1997年 1月～ 2 0 0 0年 12月我们对 78例患者采用眉区除皱与下睑袋整复同时进…     

睑皮松弛综合征

睑皮松弛症是一种不常见的,以眼睑反复水肿为特征的眼病。随时间的推移,眼睑组织也发生病理改变。上睑下垂及眶脂肪、泪腺脱垂造成上眼睑畸形,个别病例继发眦部韧带断裂致眼裂狭小,晚期韧带和眼睑组织间失去固着,眼裂出现明显的水平性缩短,外眦角亦成环形畸形,上睑皮肤显得过多可影响视力,本症应与遗传性皮肤松弛及正常衰老过程的睑皮松弛相鉴别。本病见于青年,无性别差异,80%以上在20岁前发病。双眼上睑无痛性水肿反复发作,水肿无凹陷性,对应用抗组织胺及强的松类药物不敏感,严重者始影响下睑,很少单眼发病。许多患者发生在     

下睑内翻和上睑肥厚性单睑及内眦赘皮一期手术观察

目的 探讨下睑内翻和上睑肥厚性单睑及内眦赘皮一期进行的手术方法和美容效果.方法 先进行睑裂横径和内眦间距的测量,根据测量值设计新内眦点,采用睫毛周边切口矫治内眦赘皮.平行上下睑缘剪开内眦赘皮达新内眦点,分离上下皮瓣与眼轮匝肌,将原内眦点的皮肤与新内眦点皮肤缝合.下睑睫毛下1.5 mm横贯切口与内眦皮瓣相连,分离皮肤达眶下缘,白睑缘下2 mm分出宽4 mm肌肉瓣,在近外眦处将其缩短3～4 mm,7-0尼龙线间断缝合皮肤.上睑沿重睑设计线切开,下唇分离至睫毛根部,剪除其下多余组织,上唇去除一窄条皮肤直达内眦皮瓣并将其多余处剪除,打开眶隔剪除脱出脂肪组织,中间挂提上睑肌腱膜后间断缝合皮肤.结果 本组16例32只眼,上、下睑内翻均得到矫正,重睑自然,睑裂明显变长开大,内眦赘皮消失.结论 采用此种联合手术方法做出的眼睛,不但治疗了疾病,而且达到了美容的目的,值的推广应用.     

Merkel cell carcinoma of the eyelid and periocular tissues.

Five patients had eyelid and periocular Merkel cell carcinoma. The tumor was located on the left lower eyelid in two patients, the left upper eyelid in one patient, the right upper eyelid in one patient, and was metastatic to the right outer canthus in one patient. The mean duration of symptoms was approximately four months. The diagnosis of Merkel cell carcinoma was not suspected clinically in any of the four primary eyelid cases, but was only established on histopathologic examination of biopsy specimens. Light microscopy disclosed carcinoma with small primitive cells in all five tumor biopsy specimens. Immunohistochemical studies showed neuron-specific enolase and keratin and transmission electron microscopy demonstrated neurosecretory granules typical for Merkel cell carcinoma. All five patients in this study were treated with wide surgical excision of the eyelid tumors with intraoperative frozen-section monitoring of the margins of resection. The left lower eyelid Merkel cell carcinoma spread to the preauricular lymph node in one patient. This patient subsequently died of metastatic Merkel cell carcinoma. One patient with metastatic right outer canthus Merkel cell carcinoma received radiotherapy (6,550 cGy). Eyelid Merkel cell carcinoma has the potential for recurrence and metastatic spread. We recommend lifetime follow-up for patients treated for eyelid Merkel cell carcinoma.     

"Madame Butterfly" procedure: combined cheek and lateral canthal suspension procedure for post-blepharoplasty, "round eye," and lower eyelid retraction

The most common complication of lower eyelid blepharoplasty is eyelid retraction ("scleral show") of the lateral one-third of the lower eyelid, with associated rounding and inferior displacement of the lateral canthus. A procedure in which the middle lamellar cicatrix is lysed, the lateral canthus reconstructed, and the cheek elevated to provide additional vertical anterior lamellar skin is described. Skin grafting is often aesthetically poor in the lower eyelid and is unacceptable in the upper eyelid. This new procedure may be used to elevate the lower eyelid rather than lower the upper eyelid in cases of post-blepharoplasty lagophthalmos with exposure keratopathy. Thus, the procedure offers cosmetic and functional repair, without the use of skin grafts, for the patient who would normally need upper and lower eyelid skin grafting.     

M成形术矫正内眦赘皮

目的探讨一种简单有效的内眦赘皮矫正方法。方法应用内眦劈开、插入局部皮瓣和两个三角形皮肤切除的M成形术矫正内眦赘皮46例，其中与重睑同时进行41例，重睑术后内眦开大5例。结果46例内眦赘皮明显的患者术后效果满意。术后1月内有3例出现上睑部增生发红，5例出现内眦部增生发红，4例出现下睑部增生发红。2～3个月后逐渐软化消退。经随访3～12月，疤痕不明显，均获得满意疗效。结论M成形术设计简单、操作容易，术后内眦成形良好，疤痕不明显，值得推广应用。     

Upper eyelid island orbicularis oculi myocutaneous flap for periorbital reconstruction

PURPOSE: To describe the upper eyelid island orbicularis oculi myocutaneous flap, medially or laterally based, for reconstruction of periorbital defects. METHODS: During the past three years we have used the island orbicularis oculi myocutaneous flap in 62 patients with tumors of the periorbital area, with the following indications: (a) anterior lamellar defects of the medial aspect of the upper eyelid, when the peripheral arcade is intact; (b) up to 2/3 anterior lamellar lower eyelid defects; (c) inner and outer canthus defects; and (d) defects of the peripalpebral area (the lateral half of the eyebrow, bridge of the nose and suprazygomatic areas). RESULTS: The flap proved to be flexible, safe, relatively simple, and provided good functional and aesthetic results. Complications were minimal. CONCLUSIONS: The upper eyelid island orbicularis oculi myocutaneous flap may be a useful tool for periorbital reconstruction.     

先天性下睑内翻并内眦赘皮的手术治疗

目的:探索一种简便而有效的矫治先天性下睑内翻并内眦赘皮的手术方法.方法:患者15例29眼,采用内眦重建联合皮肤轮匝肌切除术:伴倒向型内眦赘皮者行L型皮肤轮匝肌切除术;伴其它类型内眦赘皮者行y-v成形术联合皮肤轮匝肌切除术.结果:术后随访6~12mo,所有患者下睑内翻及内眦赘皮均矫正满意,睑裂横径延长,内眦角自然,取得较好的美容效果,家长及患者满意.结论:联合手术的方法简便有效,利于下睑生理功能恢复,术后瘢痕不明显,提高了先天性下睑内翻的矫治疗效,患者术后不易复发,可作为先天性睑内翻常规手术方法.     

Simultaneous spontaneous and primary surgical repair of eyelids.

Fifteen patients with suspected malignant lesions of the lower eyelids or inner canthal region, needing large excisions, were managed as day cases with spontaneous repair and simultaneous subtotal primary surgical reconstruction under local anaesthesia. For lesions confined to the lower eyelid, only those patients requiring full-thickness margin-inclusive (FTMI) excisions of more than half the horizontal extent of the eyelid are included in this study-the largest excision being 21 x 6 mm. For malignant lesions of the inner canthus, only those patients needing moderate to large excision of inner canthal skin and orbicularis with simultaneous FTMI excision of the medial one-third (8 x 5 mm) of the upper as well as the lower eyelid are included. The 16th patient had traumatic loss of inner canthal tissue. The final cosmetic and functional results in all 16 patients were satisfactory and comparable with the results of competent and in-toto primary surgical reconstructions. For large excisions at the inner canthus spontaneous with partial primary surgical repair allows the use of a less extensive and less elaborate surgical procedure that is within the capabilities of most ophthalmic surgeons.     

The effect of omitting botulinum toxin from the lower eyelid in blepharospasm treatment

We randomly selected 26 patients with essential blepharospasm to receive either botulinum toxin or saline injection in their lower eyelids to evaluate the necessity of lower eyelid injection to relieve blepharospasm. As diplopia may occur from botulinum toxin injections for blepharospasm, most commonly from injection of the lower eyelid, and surgical relief of blepharospasm is often achieved by excision of only the upper eyelid protractors, omission of toxin from the lower eyelid seemed both desirable and possible. All patients received botulinum toxin in the upper eyelids, above the eyebrows, across the glabella, and near the lateral canthus. Thirteen of 15 patients who received saline in their lower eyelids had relief of spasm, with the same spasm-free interval as those who received toxin. We recommend avoiding injection of toxin in the medial two thirds of the lower eyelid in order to diminish the likelihood of diplopia from inferior oblique muscle paresis.     

改良Ⅰ期重睑成形联合内眦赘皮矫正术的疗效探讨

目的:探索一种设计简单、操作灵活、效果确实的Ⅰ期重睑成形联合内眦赘皮矫正术的新方法,以期达到自然、美观的眼部外形.方法:选取2011-09/2015-05采用Ⅰ期重睑成形术联合内眦赘皮开大术矫治单睑合并内眦赘皮患者62例124眼,包括对双上睑单睑常规行切开法重睑术,向内眦部延长重睑线切口,将内眦切口隐蔽在重睑线内;随后松解纵形内眦韧带,并重新定位理想的内眦形态,以减少内眦部皮肤张力;再根据新定位内眦形态适度去除多余皮肤组织,同时矫正双上睑单睑合并内眦赘皮外形.术后3mo~1a对患者进行随访,随访时间点分别为3、6mo,1a,在以上时间点对患者双上睑重睑的形态及内眦形态、内眦瘢痕等进行观察.结果:患者57例114眼获得3mo~1a的完整随访.通过对随访的57例114眼患者的重睑形态进行评估,永久性重睑、内眦赘皮矫正充分,形态满意者51例102眼,内眦赘皮部分矫正、形态改善者6例12眼,所有随访患者均未见内眦赘皮复发及严重瘢痕增生.结论:将内眦开大术与重睑成形术同期施行,内眦开大充分,切口隐蔽,可按实际皮肤量切除皮肤,术后切口瘢痕隐蔽,能够有效地解决内眦部皮肤的张力分布,获得永久性重睑和自然的内眦开大效果,是矫正单睑合并内眦赘皮的理想手术方法.     

风筝皮瓣修复眼睑前层及中面部皮肤缺损

目的 评价风筝皮瓣修复合并或不合并中面部皮肤缺损的眼睑前层缺损的疗效.方法 自2008年1月至2010年3月,以面部皮下组织为蒂,设计"风筝"皮瓣,联合或不联合硬腭黏膜移植,修复合并或不合并中面部皮肤缺损的眼睑缺损共10例.眼睑前层或和中面部皮肤缺损面积为(1.2～6.5)cm2、(0.7～4.0)cm2.其中下眼睑中央水平方向4/5、垂直方向完全全层缺损合并颧颊部皮肤缺损1例,下睑内侧水平方向1/2、垂直方向完全全层缺损、下泪小点下泪小管缺损合并中面部皮肤缺损1例,下睑水平及垂直方向均完全全层缺损合并下泪小点及下泪小管缺损1例,上下睑水平方向完全、垂直方向1/3全层缺损合并上下泪小点泪小管缺损1例,下睑中央水平方向4/5、垂直方向完全全层缺损合并颧颊部皮肤缺损1例,全上眼睑前层及颞部皮肤缺损1例,下睑内侧水平方向1/3、垂直方向1/5前层缺损1例,上下睑中央水平方向2/3、上睑垂直方向1/3,下睑垂直方向2/3全层缺损1例,上下睑内侧1/3前层及内呲内侧皮肤缺损合并上下泪小点缺损1例,外眦外侧前层及颞部皮肤缺损1例.结果 皮瓣均无张力修复缺损,皮瓣及硬腭黏膜均全部成活,眼睑外形、功能完全恢复.结论 风筝皮瓣是修复眼睑缺损及面部皮肤缺损的良好方法.

Abstract：

Objective To evaluate the effect of rehabilitating the anterior 1amella of eyelids and midfacial skin defects with kite flap.Methods From January 2008 to March 2010,with or without combination of a hard palate mucosal grafts,the kite flap on a subcutaneous pedicle have been used to repair defect in the anterior lamella of eyelids and midfacial skin in 10 patients.The area of the defect in the anterior lamella of eyelids and midfacial skin ranged from(1.2～6.5)×(0.8～4)cm.Among them,defects span central 4/5 in horizontal direction and complete in vertical direction in full-thickness lower eyelid and partes zygomatica skin in 2 patient,medial 1/2 in horizontal direction and complete in vertical direction and puncta and canaliculus in full-thickness lower eyelid and midface skin in 1 patient,complete lower eyelid and inferior puncta and canaliculus in 1 patient,complete in horizontal direction and 1/3 in vertical direction and puncta and canaliculus both in full-thickness upper and lower eyelids in 1 patient,complete anterior layer of upper eyelid and temples skin in 1 patient,medial 1/3 in horizontal direction and 1/5 in vertical direction in the anterior lamella of lower eyelid in 1 patient,central 2/3 in horizontal direction and 1/3 in vertical direction in full-thickness upper eyelid,and central 2/3 in horizontal direction and 2/3 in vertical direction in full-thickness lower eyelid in 1 patient,medial 1/3 of anterior lamella and puncta and canaliculus both in upper and lower eyelid and inside skin of medial canthus in 1 patient,outside skin of outer canthus and temples skin in 1 patient.Results All flaps and hard palate mucosal grafts were survived.All defects were repaired without tention.The cosmetic appearance and function of eyelids rehabilitated.Conclusions The kite flap provides a competitive method for repairing the anterior lamella of eyelids and facial skin defects.