游离鼻中隔粘膜软骨植片在上睑重建中的应用

目的 探讨游离鼻中隔粘膜软骨植片在眼睑缺损重建修复中的效果。方法 采用自体鼻中隔单侧粘膜及软骨游离植片对13例上眼睑肿瘤切除及2例陈旧性外伤上睑全层缺损重建修复,替代缺损的睑板及睑结膜。结果 15例全部成活,眼睑外观良好,眼睑形态及运动功能恢复正常,无干涩及异物感,无睑内外翻、畸形等并发症发生。结论 利用自体鼻中隔粘膜软骨游离植片作睑板及睑结膜修复材料,具有取材方便、效果好的特点,是一种较为理想的方法。     

带黏膜的鼻中隔软骨在眼睑重建中的应用

目的:探讨自体带鼻黏膜的鼻中隔软骨修复眼睑恶性肿瘤切除后眼睑大范围缺损的疗效。方法:对7例上睑恶性肿瘤切除后用自体带鼻黏膜的鼻中隔软骨修复睑板缺损并重建眼睑。结果:对7例患者术后随访6mo～2a,带鼻黏膜的鼻中隔软骨生长良好,重建的眼睑外观良好和功能不受影响。结论:自体带鼻黏膜的鼻中隔软骨修复眼睑恶性肿瘤切除后眼睑大范围缺损,手术效果好,而且是一种方便、损伤小的眼睑重建手术。     

眼睑肿瘤切除及鼻中隔软骨粘膜游离移植修复睑板术的应用

眼睑肿瘤临床较为常见,瘤体超过1×1cm者手术摘除后往往引起局部眼睑闭合不全,易使眼球受损及外形受到很大影响.我们在摘除肿瘤的同时采用鼻中隔软骨粘膜游离移植修复睑板,可避免以上缺陷,效果良好.1983年以来共做5例,现介绍如下.     

鼻中隔软骨粘膜片和耳后皮瓣修复上睑全层缺损

患者 ,男 ,41岁 ,住院号 0 80 841,左眼睑被他人咬伤 2小时入院。检查 :右眼上睑中部有 15ｍｍ× 10ｍｍ范围全层缺失 ,仅在靠距内、外眦角残留少量睑板边缘组织 ,上方眼轮匝肌组织及穹隆结膜暴露 ,球结膜显著充血、水肿 ,角膜上皮水肿明显 ,荧光素钠染色 (-) ,角膜后ＫＰ(-) ,房水闪光 (-) ,前房深浅适中 ,瞳孔对光反应良好 ,余窥不进。诊断 :右眼睑咬伤 ,上睑全层缺损。手术方法 :常规消毒整个颜面区域及右耳后皮肤 ,清理创面并测量缺损范围。局部麻醉后 ,入左侧鼻孔纵形切取 15ｍｍ× 10ｍｍ大小带有鼻粘膜的鼻中膈软骨瓣 ,尽量避免穿孔 …     

耳轮脚软骨代替睑板行上睑成形术

目的：探讨在上眼睑成形手术中以耳轮脚软骨替代缺损的睑板临床应用的效果。方法：切取耳轮脚软骨移植片游离移植在缺损的睑板位置上方与上睑提肌腱膜相缝合，两侧与残余睑板组织相缝合，下边睑缘部游离缘由上面的皮肤，下面的球结膜移植片以及软骨植片相缝合，结果：术眼外观无畸形，供体部位耳轮脚无畸形，上睑开闭正常，结论：应用耳轮脚软骨可替代耳壳软骨在眼睑成形手术中修补缺损的睑板组织，特别适宜于睑板缺损较小的患者。     

桥状皮瓣加自体软骨移植术在全上睑缺损修复中的应用

眼睑肿瘤是眼科常见肿瘤,而手术切除是最常用最主要的治疗方法。术后眼睑成形重建在眼睑肿瘤切除术后显得至关重要。近几年来,我院对7例上睑肿瘤切除术后全上睑缺损修复中运用桥状皮瓣加自体软骨移植术,取得较满意效果,现报告如下一、资料与方法1.一般资料:本组共7例(7只眼),其中男性4例,女性3例。年龄52~71岁,术后病理确诊为睑板腺癌5例、基底     

用自体足底皮代替睑板行眼睑再造的初步报告

目的：探讨用自体足底皮代替睑板行眼睑再造术的效果。方法：对１１例（１１眼眼睑）由于切除肿瘤和外伤造成眼睑缺损病例施行手术。其中上睑９例,下睑２例。眼睑完全缺损６例,２／３缺损３例,１／２缺损２例。年龄２４～８０岁,平均５８．６岁。用自体足底皮代替睑板行眼睑再造。结果：追踪观察６～４２个月,治愈９例,好转２例,无明显并发症。结论：自体足底皮取材简便,易于成形,经济实用,是一种比较理想的睑板替代材料。     

自体睑板移植修复1/2眼睑缺损

自 2 0 0 1年 7月以来 ,我们以自体健眼睑板移植片一期修复肿瘤切除后的 1/2眼睑缺损 ,取得满意效果。现将我院的治疗结果和具体技术介绍如下。一般资料 :11例因眼睑肿块就诊的患者 ,男性 4例 ,女性 7例 ,年龄 42～ 78岁 ,平均 61岁 ;右眼 5例 ,左眼 6例 ,上睑 7例 ,下睑 4例。其中 ,8例患者已行肿块活检 ,病理证实为“睑板腺癌” ;其余 3例临床上呈现典型的睑板腺癌征象 ,即睑结膜面白色结节样隆起。全部病例肿瘤范围不大于6mm ,均未侵入穹隆部 ,耳前、颌下淋巴结未及肿大。方法 :①自体睑板的制备 :地卡因表面麻醉 ,利多卡因穹隆部浸润麻…     

自体游离硬腭粘膜移植修复眼睑缺损

目的探索自体硬腭粘膜修补眼睑缺损的效果。方法动物实验：３只狗的１２只眼睑，自体硬腭粘膜修补人为眼睑缺损。观察２２周，眼睑外形修复。病理检查上皮形态、厚度恢复，结缔组织内细胞及毛细血管数量呈正常水平，胶原纤维束排列整齐。临床研究：收治１３例（１５只睑）眼睑缺损患者，其中上睑３例，下睑８例，上、下睑２例。肿瘤导致缺损５例，外伤造成缺损８例。完全缺损６只睑，２／３缺损４只睑，１／２～１／３缺损５只睑。年龄２２～７９岁。采用脂肪区中厚硬腭粘膜植片修补眼睑缺损。结果术后观察平均１１．３个月。治愈８只睑，显效３只睑，改善４只睑。无严重并发症发生。结论自体硬腭粘膜移植不仅能替代睑板起支架作用，同时可修补睑结膜缺损。     

Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft

Purpose: To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery.Methods: This was a retrospective case-series of 8 patients who underwent reconstruction of the upper eyelid after tumour removal. The horizontal defect involved 50–75% of the lid (3 pts.), more than 75% (3 pts.), and more than 75% plus the lateral canthus (2 pts.). The posterior lamella was reconstructed with contralateral upper eyelid tarsal plate. The anterior lamella was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free skin graft.Results: All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after excision to avoid eye discomfort.Conclusion: Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases.     

异体睑板移植修复眼睑缺损

目的 修复21眼因各种原因所致的部分或全层眼睑缺损。方法 采用低温保存的异体睑板移植替代瞪板,内层行结膜转移或唇粘膜移植。外层应用邻近带蒂皮瓣或游离显效5眼,改善2眼,失败1眼,术后效果与血运 的好坏和移植片的大小有关。结论 采用低温保存的异体睑板修复眼睑缺损,排斥反应轻,疗效佳。是替代睑板的理想材料。     

Total or subtotal replacement of tarsal plate by novel silicone plate for upper eyelid reconstruction in malignant tumors

Purpose:To evaluate the cost, safety, surgical outcome, and efficacy of modified Cutler–Beard eyelid reconstruction utilizing a novel silicone plate as a tarsal plate replacement in the repair of 60% to 100% eyelid defects following the excision of large malignant tumors.Methods:A prospective, noncomparative, interventional study of 30 eyes was done over 3 years. Fourteen patients were female, and 16 patients were male. In all the cases, a silicone plate, the synthetic, artificial tarsal plate, was utilized for a total or subtotal replacement of the tarsal plate. The created defect was measured in mm (length and width) and later expressed in percentage. Pre- and postoperative action of levator palpebrae superioris (LPS) was measured. Pre- and postoperative measurements of the margin-to-margin reflex distance (MRD1) were noted.Results:Preoperative LPS action was 1.23 ± 1.35 mm, whereas postoperative LPS actions at the end of 1 week and 18 months were 11. 8 ± 0.88 mm and 13.53 ± 0. 73 mm, respectively. Preoperative MRD1 was − 3.0 ± 1.144 mm, whereas postoperative MRD1 values at the end of 1 week and 18 months were 2.18 ± 0.27 mm and 4.16 mm ± 0.35, respectively. The mean created defect after the removal of the tumor was 87.3% ±11.10. The mean length of the silicone plate implanted in this study was 27.53 ± 2.48 mm. The follow-up period for the study participants was 18 months.Conclusion:The synthetic novel silicone plate was successful as a tarsal plate replacement. A second surgical site for ear cartilage harvesting is avoided. Cadaver transfer of Achilles tendon carries the risk of transmission of communicable diseases, for example, hepatitis B and HIV. Silicone is an inert, nonreacting, and tissue-tested material, thus eliminating the possibility of graft rejection. This material is readily available and cost-effective. The novel silicone plate is considered to be the most promising alternative material as a tarsal replacement in the future generation.     

下睑缩肌复位联合外侧睑板条固定术治疗退行性下睑内翻

目的：探讨并比较下睑缩肌复位联合外侧睑板条固定术及单纯下睑缩肌复位术治疗退行性下睑内翻的有效性和安全性。

方法：本研究为前瞻性研究。选取2015-01/2018-02在我科接受手术治疗的退行性下睑内翻患者79例91眼,随机分为观察组(41例46眼,行下睑缩肌复位联合外侧睑板条固定术)和对照组(38例45眼,行单纯下睑缩肌复位术),对两组临床疗效、术后并发症发生率进行比较。

结果：术后3mo随访,两组患者治愈率无差异(100% vs 98%,P=0.495)。术后24mo随访,观察组治愈率高于对照组(98% vs 84%,P=0.030)。观察组无术后并发症发生,明显少于对照组(11%,P=0.026)。

结论：下睑缩肌复位联合外侧睑板条固定术治疗退行性下睑内翻较单纯下睑缩肌复位术远期治疗效果佳,并发症少。     

保存异体睑板修复睑板缺损的临床观察

目的观察眼睑肿瘤术后保存异体睑板Ⅰ期修复睑板缺损的疗效。方法采用纯甘油保存的异体睑板,对58例眼睑肿瘤切除术后的患者行Ⅰ期睑板缺损修补术,用转位或滑行肌皮瓣和结膜瓣铺衬于异体睑板两侧。分析异体睑板的血运环境、异体睑板大小、保存时间与手术疗效的关系。术后随访3个月至10.5年,平均1.8年。结果58例中,43例异体睑板结膜瓣遮盖完全,术后1周异体睑板内可见新生血管,1个月后新生血管布满整个植片;15例异体睑板结膜瓣遮盖不全,术后2～3个月新生血管长满植片,而裸露部位的植片表层可见不同程度的融解。不同大小结膜瓣间的植片愈合效果比较,差异有显著性（χ     

探讨Medpor下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻

目的　探讨Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻的临床疗效。方法　回顾性系列病例研究。收集１６例（１６眼）重度麻痹性下睑外翻患者的临床资料,所有患者均采用Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗。记录并比较１６例患者术前及术后１周、３个月、１２个月的眼睑闭合不全量、下睑退缩量、角膜上皮分级、下睑水平及垂直松弛度等级。结果　１６例患者术后下睑外翻均矫正,随访期内均未见复发。术后１周、３个月、１２个月,下睑退缩量、眼睑闭合不全量均较术前明显下降,差异均有统计学意义（均为Ｐ＜０．０５）;术后各时间点间比较,差异均无统计学意义（均为Ｐ＞０．０５）。随访期间各患者的角膜上皮分级、水平及垂直松弛度等级均较术前明显改善,随访期末均为０级或１级。无１例患者术后出现眶内出血、感染及内植入物暴露、排斥、移位等严重并发症。结论　采用Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻,可在保留患者视功能的前提下矫正下睑外翻及眼睑闭合不全,有效改善患者眼表状况及外观,且术后效果较为稳定。     

应用外翻严重度评分评价涤纶心脏补片联合睑板缩短术治疗麻痹性下睑外翻的手术疗效

目的 应用外翻严重度评分（ESS）评价涤纶心脏补片联合睑板缩短术治疗麻痹性下睑外翻的手术疗效。设计 回顾性病例系列。研究对象 2017年5月至2019年6月北京同仁医院手术治疗的麻痹性下睑外翻患者7例（7眼）,其中男性5例（5眼）,平均年龄（70±9）岁。方法 手术方法为将涤纶心脏补片修剪至合适尺寸后内侧固定于内眦韧带及内侧眶缘,外侧固定于外侧眶缘,同时联合行睑板缩短术。基于眼外观照相的ESS对下睑外翻的位置和程度,有无巩膜暴露、睑结膜暴露、泪膜过多、结膜充血、眦角圆顿、泪小点外翻的体征逐项评分,最高分为8分。应用ESS评分评价术前下睑外翻严重度及术后疗效。平均随访（19±10）个月。主要指标 ESS评分及手术并发症。结果 术前ESS评分4.5~8分,中位数为8分;术后随访终点ESS评分0~1分,中位数为0分;较术前显著好转（Z=-0.756,P=0.017）。无欠矫及复发,成功率100%。植入物无移位或脱位。结论 涤纶心脏补片联合睑板缩短术应用于麻痹性下睑外翻的治疗安全有效,外翻严重度评分是一种直观并可量化的评价方法。（眼科, 2020, 29： 386-390）     

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。