额肌瓣与提上睑肌腱膜瓣吻合矫正重度上睑下垂

目的：探讨额肌瓣和提上睑肌腱膜瓣吻合术矫正重度上睑下垂的疗效。方法：对36例（43眼）重度先天性上睑下垂患者行额肌瓣和提上睑肌腱膜瓣吻合矫正术,术后随防3个月～2年,平均13个月。结果：矫正良好31例,矫正尚可5例,无矫正不良者。结论：额肌瓣与提上睑肌腱膜瓣吻合术矫正重症上睑下垂较传统单纯额肌瓣悬吊术操作简单,损伤小,并发症少,手术成功率高,更符合生理解剖特点,矫正重症上睑下垂安全可靠。     

两种不同术式矫正不同程度先天性上睑下垂的效果探讨

目的:探讨提上睑肌缩短术和额肌瓣悬吊术这两种术式对于不同程度先天性上睑下垂的矫正效果。方法:回顾性分析2000年-2008年在笔者医院接受提上睑肌缩短术或额肌瓣悬吊术的先天性上睑下垂患者37例53眼的临床资料,根据手术方式的不同,将其分为提上睑肌缩短术组(n=17)和额肌瓣悬吊术组(n=20),比较两组不同程度先天性上睑下垂的矫正效果及术后并发症发生率。结果:提上睑肌缩短术对于轻度上睑下垂的正矫率为87.5%高于额肌瓣悬吊术组的55.6%,差异有统计学意义(P0.05)。提上睑肌缩短术对于中、重度上睑下垂的正矫率分别为30.0%、50.0%,低于额肌瓣悬吊术组的90.0%、90.0%,差异有统计学意义(P0.05)。提上睑肌缩短术组的并发症发生率为17.7%低于额肌瓣悬吊术组的20.0%,但两组间比较差异无统计学意义(P0.05)。结论:提上睑肌缩短术适用于轻度先天性上睑下垂;额肌瓣悬吊术适用于中、重度先天性上睑下垂。     

涤纶网织带额肌悬吊术治疗儿童上睑下垂

目的 探讨额肌悬吊术对儿童先天性上睑下垂手术的效果。方法 对164例（200只眼）儿童先天性上睑下垂进行涤纶网织带额肌悬吊要，采用自制隧道穿针，随访时间3个月至2年，平均5．24个月。结果 术后达正矫166只眼，占83％；低矫32只眼，占16％；过矫2只眼，占1％。眼睑外莆满意。结论 涤纶网织带额肌悬吊术治疗儿童先天性上睑下垂可取得良好效果，该手术适于各类上睑下垂儿童。     

矫正重度上睑下垂的临床体会

上睑下垂是整形外科中常见的疾病之一.而重度上睑下垂不但影响视觉功能,还会因眼部缺陷而影响面部容貌.自2000年1月至2010年7月,我们分别采用额肌瓣悬吊术[1]、提上睑肌腱膜瓣-额肌吻合术、改良方形缝线悬吊术的方法矫重度上睑下垂患者108例,效果满意.现报道如下.     

单纯额肌瓣悬吊术治疗重度先天性上睑下垂的临床观察

目的:探讨额肌瓣悬吊术治疗先天性上睑下垂的可行性.方法:对23例30只眼的重度先天性上睑下垂采用额肌瓣悬吊,利用额肌的力量提起上睑.结果:23例30只眼矫正满意27只眼,矫正良好3只眼,矫正不良0只眼.结论:额肌肌瓣悬吊术是治疗重度先天性上睑下垂有效的主要的手术方式.     

提上睑肌腱膜折叠前徙术在腱膜性上睑下垂术中的应用

目的:评价提上睑肌腱膜折叠前徙术治疗腱膜性上睑下垂的手术效果。方法:采用经皮肤入路提上睑肌腱膜折叠前徙术,术后观察对称性、眼睑高度和外形及启闭功能,随访6～12个月。结果:术后4只眼在观察期间出现欠矫,且双眼不对称,经再手术矫正,有2只眼复发行额肌腱膜悬吊术矫正。结论:大部分腱膜性上睑下垂患者术后可获得外观改善和对称的眼睑高度及外形,术中反复调整折叠肌量和精细的操作可减少手术并发症。     

单切口额肌上睑SMAS瓣经眶隔后悬吊治疗上睑下垂

目的 总结单切口额肌上睑SMAS瓣经眶隔后悬吊治疗上睑下垂的适应证及手术方法.方法 取上睑重睑皱襞切口,SIFSF悬吊治疗上睑下垂,重建上睑提升动力通道近似上睑提肌滑行路径.自1993年7月至2009年11月,收治上睑下垂148例(215只眼),其中应用SIFSF经眼轮匝肌和眶隔后隧道悬吊治疗上睑下垂者81例(121只眼),包括严重或复发性上睑下垂、Horner′s 综合征、张口瞬目综合征、先天性睑裂狭小综合征和下颌面发育不良综合征伴有的上睑下垂等;应用上睑提肌腱膜缩短,提上睑肌粘连松解,节制韧带松解,睑板部分切除治疗上睑下垂67例(94只眼).结果术后早期发生睑内翻、角膜刺激者1 例,再次手术治愈;角膜溃疡者1例,经治疗好转;结膜脱垂者2例,术后血肿者2例,经保守治疗痊愈.在SIFSF悬吊治疗上睑下垂的81例(121只眼)患者中,术后经4周至10年随访者49例(69只眼),其中优良者30例( 45只眼),良好者17例(22只眼),矫正不足者2例(3只眼),矫正优良率为97%.术后提上睑功能和形态良好.矫正不足2例,经再次手术治愈.结论 单切口额肌上睑SMAS瓣经眶隔后悬吊治疗上睑下垂术式,可避免眉下切口,是一项符合上睑提肌生理功能的重建,适应证范围较广,手术操作简易,术后提上睑功能和上睑形态改善良好的手术方法.     

上睑提肌腱膜瓣-额肌吻合术与上睑提肌缩短及徙前术矫治上睑下垂的疗效对比

目的:探讨上睑提肌腱膜瓣-额肌吻合术与上睑提肌缩短及徙前术对上睑下垂的手术效果差异。方法:选取笔者医院2015年1月-2016年12月实施手术治疗的100例(180眼)重度上睑下垂患者进行回顾性分析,根据手术方法分为上睑提肌腱膜瓣-额肌吻合术组(50例,94眼)、上睑提肌缩短及徙前术组(50例,86眼),比较两组患者的术后手术效果、术后不同时间点的上睑回退量、并发症发生情况。结果:上睑提肌腱膜瓣-额肌吻合术组术后达到1级的有84眼(89.36%)、达到2级的有10眼(10.64%);上睑提肌缩短及徙前术组术后达到1级的有63眼(73.26%)、达到2级的有18眼(20.93%),两组比较差异有统计学意义(P0.05)。术后6个月、9个月、1年,上睑提肌腱膜瓣-额肌吻合术组的上睑回退量均显著低于同一时间点的上睑提肌缩短及徙前术组,差异有统计学意义(P0.05)。上睑提肌腱膜瓣-额肌吻合术组的术后并发症发生率为4.26%显著低于上睑提肌缩短及徙前术组的15.12%,差异有统计学意义(P0.05)。结论:上睑提肌腱膜瓣-额肌吻合术治疗上睑下垂手术效果可靠、术后上睑回退量小、手术并发症少。     

先天性上睑下垂手术疗效临床分析

先天性上睑下垂是由于提上睑肌发育不全,缺失或支配神经发育障碍导致的一种先天性眼睑疾病.由于上睑下垂的程度不同,临床表现各异,严重影响患者的容貌及视功能,甚至造成弱视,多数患者以美容为目的而就诊,十分重视上睑下垂的治疗效果.我科对先天性轻、中度上睑下垂,采用高位打开眶隔行提上睑肌缩短术和对重度先天性上睑下垂行额肌瓣腱膜悬吊术,获得了满意的治疗效果.     

联合筋膜鞘+提上睑肌复合瓣悬吊矫治先天性重度上睑下垂

目的:探讨联合筋膜鞘+提上睑肌复合瓣悬吊治疗先天性重度上睑下垂的临床效果。方法:选取2017年9月至2019年3月于河北省眼科医院住院的先天性重度上睑下垂患者205例248眼,随机分为三组,分别应用联合筋膜鞘+提上睑肌复合瓣悬吊术(CFS+L复合瓣悬吊组)、联合筋膜鞘悬吊术(单纯CFS悬吊组)、额肌瓣悬吊术(额肌瓣悬吊组)加以矫正;随访6个月,比较三组患者正矫率、上睑回退率、上睑活动范围及眼睑闭合不全情况、并发症发生率和患者满意度。结果:CFS+L复合瓣悬吊组较其他两组有更高的正矫率,CFS+L复合瓣悬吊组及单纯CFS悬吊组术后较额肌瓣悬吊组有更好的上睑活动度、眼睑闭合不全状态较轻、并发症发生率较低,患者满意度较高;CFS+L复合瓣悬吊组较单纯CFS悬吊组术后上睑回退率低、具有更好的稳定性;差异均有统计学意义(P<0.05)。结论:联合筋膜鞘+提上睑肌复合瓣悬吊术矫正先天性重度上睑下垂具有治愈率高、效果更加稳定的特点,是一种符合眼睑活动生理学特点的动态术式。     

Strategies for Simultaneous Double Eyelid Blepharoplasty in Asian Patients With Congenital Blepharoptosis

Background Most patients with blepharoptosis prefer to undergo a double eyelid operation and a ptosis repair simultaneously to achieve the optimal cosmetic and functional result. However, it is difficult to achieve symmetry in patients with blepharoptosis. Methods Surgery was performed on the levator aponeurosis or frontalis muscle to correct blepharoptosis while double eyelid surgery was simultaneously performed to correct blephroptosis in 264 patients over the past 15 years. This report describes 39 representative cases of unilateral congenital blepharoptosis and 30 representative cases of bilateral congenital blepharoptosis. In cases of unilateral ptosis with good or fair levator function, a levator resection or plication was performed, and the position of the lid margin was adjusted to 1 to 2 mm below the upper limbus. Cases of severe unilateral blepharoptosis were corrected by frontalis muscle flap, orbicularis oculi muscle flap, or frontalis myofacial flap, and the height of the double eyelid was created to be 1 to 2 mm less than the height on the normal side. The position of the lid margin was adjusted to the level of the superior limbus, and the height of the lid crease of the ptotic eye was determined to be according to that on the nonptotic side. For bilateral ptosis patients with equal levator function, the height of the double eyelid was designed symmetrically. Bilateral blepharoptosis patients with unequal levator muscle function should have the double eyelids on both sides created the same as in normal cases, and they must be grafted in proportion to the severity of the blepharoptosis. If the results are unpredictable, the two-stage operation should be performed. Results Only 30% of the eyelids in this study were perfectly symmetric after the blepharoptosis operation, with 70% asymmetric. These 70% showed good symmetry immediately after surgery, but asymmetry occurred 6 months after the operation. Conclusion In blepharoptosis surgery, different techniques for double eyelids must be applied according to the method of ptosis correction used. Usually, the height of the double eyelid on the ptotic side should be a little less than the normal double eyelid height on the nonptotic side. However, it is difficult to achieve symmetric double eyelids in blepharoptosis patients.     

An alternative frontalis suspension technique: triband suspension--a modified Garcia's procedure

Blepharoptosis surgery is one of the most common oculoplastic procedures, and the aim is to clear the visual axis. Many surgical techniques for the correction of ptosis have been described and performed, but the operative approach is based on the extent of eyelid excursion, the amount of levator function, and the degree of ptosis.In this study, the frontalis sling procedure with triband suspension was performed on 32 eyelids of 23 patients. All the patients had visual loss because of blepharoptosis with only 0 to 3 mm of measurable levator function. Postoperatively, the palpebral fissure was increased in all the patients. The purpose of this study was to report the use of a modified frontalis sling procedure for congenital ptosis patients with minimal to no levator function. In conclusion, this modified frontalis sling technique if used maximizes the frontalis muscle, creating sufficient eyelid elevation, with stable effect over time.     

Comparison of levator resection and frontalis muscle transfer in the treatment of severe blepharoptosis

BACKGROUND: The optimal surgical approach for blepharoptosis is dependent upon many factors, the most important being levator function. However, the preferred approach in severe blepharoptosis remains a matter of contention. METHODS: We investigated 130 patients with levator function between 2 and 4 mm who underwent corrective surgery for blepharoptosis between January 1990 and December 2004. There were 65 eyelids of levator resection performed in 50 patients and 105 eyelids of frontalis transfer performed in 80 patients. Postoperative results were evaluated, with an average follow-up period of 27 months. RESULTS: The average preoperative degree of ptosis was approximately 2.7 mm in cases treated with levator resection and 4.0 mm in cases treated with frontalis muscle transfer. The average postoperative level of ptosis was approximately 1.7 mm in levator resection and 2.1 mm in frontalis muscle transfer. The average degree of postoperative ptosis improvement was approximately 1.0 mm in levator resection and approximately 1.86 mm in frontalis muscle transfer. The most frequent complication of levator resection was undercorrection. Eyelid deformity due to excessive traction was more frequent in the frontalis muscle flap technique. CONCLUSION: Levator resection and frontalis transfer can effectively treat blepharoptosis patients with poor levator function. Frontalis muscle transfer should be performed more carefully in operation to avoid complications which too excessive contraction could cause for blepharoptosis patients with 2 approximately 4 mm of levator function. Also, some accessorial methods were regarded as necessary to prevent undercorrection in performing levator resection.     

不对称双侧先天性上睑下垂的分期手术治疗策略

目的 探讨不对称的先天性双侧上睑下垂进行分期手术的治疗策略。方法 对2011年至2013年的30例不对称双侧上睑下垂患者进行分期手术矫正。一期手术矫正较重侧(中~重度),行睑板部分切除联合上睑提肌缩短前徙术;3~6个月后再行较轻侧矫正,行睑板部分切除术或上睑提肌缩短术。术后随访3~24个月,术后评估内容包括矫正程度与双侧对称性。结果 全部30例患者60只眼,在矫正效果评估中,37(61.7%)只眼为充分矫正,23(38.3%)只眼为中等矫正,无矫正不足或过矫病例。对称性评估中,23(76.5%)例达到良好对称,7(23.5%)例达到中等对称,无对称不佳病例。结论 与我们以往的治疗经验相比,对于不对称的双侧先天性上睑下垂,分期手术治疗能够达到更好的对称效果。     

上睑提肌内限制韧带松解在治疗先天性上睑下垂中的意义

目的 在睑板上缘附近的上睑提肌内，有跨于内外眦角之间数条横向纤维束带即限制韧带，我们探讨其在治疗先天性上睑下垂中的意义。方法 将此韧带松解，可基本矫正大部分经度上睑下垂病例。若为轻，中度上睑下垂，且韧带松解后上睑仍有部分下垂，还需进行睑提肌腱膜折叠术。重度上睑下垂韧带松解后，还需进行眉区额肌筋膜瓣悬吊术。结果 本组27例随访3个月～1年，27例40只眼中38只眼轻、中、重度上睑下垂均矫正满意，2只眼良好，未见睑下垂复发。结论 松解上睑提肌内限制韧带，有助于恢复上睑提肌睑功能，易于矫正睑下垂且手术创伤小，形态自然，不易复发。     

应用不同术式矫正先天性上睑下垂的疗效比较

目的比较应用上睑提肌缩短术和额肌筋膜瓣悬吊术矫正中、重度先天性上睑下垂的修复效果。方法应用上睑提肌缩短术、额肌筋膜瓣悬吊术修复先天性上睑下垂患者16例（27侧）。结果上睑提肌缩短术修复16侧，术后外形自然，兔限恢复时间短，几乎没有睑球分离发生，手术时间短，创伤小。额肌筋膜悬吊术修复11侧，术后外形欠自然，兔眼消失时间长，且常有睑球分离，手术时间相对较长，剥离范围及创伤也较上睑提肌缩短术更大，术后恢复时间长。结论上睑提肌缩短术是利用患者原有上睑提肌的力量；额肌筋膜瓣是借用额肌的力量，作用方向与上睑提肌略有不同。故上睑提肌缩短术更符合生理要求，手术效果较好。     

应用提上睑肌缩短术与额肌瓣悬吊术治疗先天性上睑下垂

目的 应用提上睑肌缩短术与额肌瓣悬吊术治疗先天性上睑下垂,依据睑下垂程度寻求最佳手术选择.方法 对47例不同程度的先天性上睑下垂患者进行了手术治疗,其中28例上睑提肌肌力在2 mm以上者选择了提上睑肌缩短术,其中28例上睑提肌肌力之间者选择了额肌瓣悬吊术;19例上睑提肌肌力在0 mm～2 mm之间者选择了额肌瓣悬吊术.结果 采用上睑肌缩短术28例,术后双眼对称者20例,6例患眼较健侧低1 mm,2例相差2 cm;采用额肌瓣悬吊术19例,术后双眼对称者12例,5例相差1 mm,2例相差2 mm.两种手术方法比较,适用提上睑肌缩短术的患者上睑皱襞弧度自然,美容效果明显.结论 额肌瓣悬吊术适用于上睑提肌肌力为2 mm以下的重度患者;上睑提肌肌力在2 mm以上的患者宜采用提上睑肌缩短术矫正,能达到提上睑功能和美容效果最大程度的恢复与改善.     

The aponeurotic approach to congenital ptosis

Using a surgical technique directed at the levator aponeurosis, we successfully corrected 228 cases of congenital ptosis. The advantages of this approach are: normal anatomic planes and structures of the eyelid are maintained; basic and reflex tear secretion, goblet cells, or meibomian glands remain undisturbed, allowing maintenance of the three-layered tear film; any aponeurotic defects may be explored and repaired relatively easily; all elevating structures are preserved (aponeurosis rather than muscular levator is removed, Mueller's muscle is left intact, Whitnall's ligament is not violated); posterior sutures, which may irritate the cornea, are avoided; no tarsus or conjunctiva are removed.     

Super-maximum levator resection for severe unilateral congenital blepharoptosis

The treatment for severe unilateral blepharoptosis is controversial. Sixteen consecutive cases of severe unilateral blepharoptosis were studied: eight had a super-maximum levator muscle resection (30 mm or more) and eight had a bilateral brow suspension with excision of the normal levator. Cosmetically acceptable results were achieved in six of eight cases undergoing a super maximum levator resection. Disparity in the palpebral fissure in downgaze ranged from 3 to 6 mm and was not bothersome to either patient or parent. Postoperative complications such as hypotropia and conjunctival prolapse can be minimized with careful technique. Four to eight cases undergoing bilateral brow suspension with excision of the normal levator had residual ptosis. Brow scars were occasionally noticeable. Overall cosmesis was considered better in the super-maximum levator resection group compared to the frontalis sling group by unbiased observers. Super-maximum levator resection is a good alternative in the treatment of severe unilateral blepharoptosis for selected cases, particularly for those who fear manipulation of the normal eyelid.