重症上睑下垂额肌筋膜瓣悬吊术临床观察

目的:观察额肌筋膜瓣转移悬吊术治疗重度上睑下垂的效果。方法:对52例72眼重度上睑下垂进行额肌筋膜瓣转移悬吊术治疗。结果:本组52例72眼随访1～6a,2例4眼矫正轻度不足,2例4眼重睑轻度不对称,其余均获得满意疗效,上睑弧度及双重睑自然美观,恢复了上睑功能。仅部分病例早期轻度睑裂闭合不全,无暴露性角膜炎等并发症发生。结论:额肌筋膜瓣转移悬吊术是治疗重度上睑下垂最理想的手术方法,手术中的上睑缘位置高低,额肌缝合睑板的位置是手术成功的关键。     

额肌瓣悬吊术治疗重度上睑下垂

目的 探讨额肌瓣悬吊术矫正重度上睑下垂的可行性。方法 对30例41眼重度上睑下垂患者将睑板于适当位置缝线后自眼轮匝肌后向上悬吊于额肌上，借助额肌力量提吊眼睑。结果 效果良好者22眼占53．7％，满意14眼占34．1％。结论 额肌瓣悬吊术治疗重度上睑下垂效果好。     

改良单一重睑切口额肌筋膜瓣悬吊术矫正儿童重度上睑下垂

目的探讨改良额肌筋膜悬瓣吊术治疗重度儿童上睑下垂的手术效果。方法采用额肌筋膜悬瓣吊术即单一重睑切口,台式勾牵拉切口上方皮肤直视下分离额肌筋膜瓣前后间隙,稍修剪内外侧角,使形成足够宽的额肌筋膜瓣,双套环缝合额肌筋膜瓣4针,对应缝于睑板中上1/3处,重睑法缝合皮肤切口。结果随访观察6～24月,平均12.5月;46眼中效果满意40眼,欠矫4眼,过矫1眼,內眦部倒睫1眼。结论改良额肌筋膜悬瓣吊术治疗重度儿童上睑下垂效果满意,完全可靠。     

改良额肌瓣悬吊矫正上睑下垂的临床应用

目的 观察改良额肌瓣悬吊矫正上睑下垂的治疗效果。方法 共150例(160眼)，男90例，女60例。施行改良额肌瓣悬吊矫正上睑下垂。结果 160眼术后有效率100％，治愈率95％。随访观察2月到3年。结论 改良额肌瓣悬吊是将额肌瓣直接与睑板缝合，术后提睑作用可靠而持久，美容效果满意。     

改良额肌瓣悬吊术治疗先天性上睑下垂

目的提高儿童中重度先天性上睑下垂的治疗效果。方法对42例（53眼）中重度先天性上睑下垂的儿童施行改良额肌瓣悬吊术：沿重睑线切开皮肤,剪除部分眼轮匝肌,显露睑板,分别作额肌与皮下、额肌与骨膜间的分离,于眉下提起并横形切断额肌,于其内侧向上切开肌瓣达眉上1-1.5cm,外侧向上剪开0.5cm,形成不等边的额肌瓣,三针褥式缝线固定于睑板上缘。结果42例53眼,切口均一期愈合,随访6月～5年,上睑下垂矫正满意,睑缘外形匀称,上睑闭合良好,无复发和并发症。结论改良式额肌瓣悬吊术治疗儿童先天性中重度上睑下垂疗效确切,远期效果较好。     

改良额肌筋膜瓣悬吊术矫治重度上睑下垂的临床疗效观察

目的 探讨改良额肌筋膜瓣悬吊术矫治重度上睑下垂的临床疗效.设计 回顾性病例系列.研究对象 56例(101眼)重度上睑下垂患者.方法 采用改良额肌筋膜瓣悬吊术,即单一重睑切口,先行分离额肌筋膜瓣后间隙,在直视下分离额肌筋膜瓣前间隙,不剪断额肌筋膜瓣内外角的方法进行矫治.主要指标 术后第一眼位上睑睑缘位置变化.结果 随访观察8～20个月,平均13.6个月.所有患者均获得满意疗效,术后反应较轻.术后并发症包括欠矫6例(10眼),过矫3例(6眼),内翻倒睫2例(2眼).结论 改良额肌瓣悬吊术治疗重度上睑下垂疗效满意,安全可靠.     

改良额肌瓣悬吊术矫治重度上睑下垂的临床疗效观察

目的 探讨改良额肌瓣悬吊术矫治重度上睑下垂的临床疗效.方法 对重度上睑下垂患者40例71只眼,采用改良的两侧不断蒂的扇形额肌瓣悬吊术进行矫治,分析术后上睑下垂矫正效果,上睑缘弧度、重睑形成及倒睫、结膜脱垂等并发症发生情况.结果 随访观察6～18个月,平均11.6个月.术后过矫6只眼(8.5%),欠矫2只眼(2.8%).其余患者睑裂对称,上睑弧度自然,重睑形成好.3个月后无回退、复发.术后并发症包括结膜脱垂2只眼(2.8%).应用皮质类固醇激素眼药水点眼,加压包扎,结膜脱垂消失;内翻倒睫1只眼(1.4%).上睑内侧1/3灰线处缝牵引缝线牵引后矫正内翻倒睫.结论 改良额肌瓣悬吊术矫治重度上睑下垂疗效满意,效果持久稳定、安全可靠.     

改良额肌瓣悬吊术矫治重度上睑下垂的临床疗效观察

目的 探讨改良额肌瓣悬吊术矫治重度上睑下垂的临床疗效.方法 对重度上睑下垂患者40例71只眼,采用改良的两侧不断蒂的扇形额肌瓣悬吊术进行矫治,分析术后上睑下垂矫正效果,上睑缘弧度、重睑形成及倒睫、结膜脱垂等并发症发生情况.结果 随访观察6～18个月,平均11.6个月.术后过矫6只眼(8.5%),欠矫2只眼(2.8%).其余患者睑裂对称,上睑弧度自然,重睑形成好.3个月后无回退、复发.术后并发症包括结膜脱垂2只眼(2.8%).应用皮质类固醇激素眼药水点眼,加压包扎,结膜脱垂消失;内翻倒睫1只眼(1.4%).上睑内侧1/3灰线处缝牵引缝线牵引后矫正内翻倒睫.结论 改良额肌瓣悬吊术矫治重度上睑下垂疗效满意,效果持久稳定、安全可靠.     

改良额肌瓣悬吊术矫治重度上睑下垂的临床疗效观察

目的 探讨改良额肌瓣悬吊术矫治重度上睑下垂的临床疗效.方法 对重度上睑下垂患者40例71只眼,采用改良的两侧不断蒂的扇形额肌瓣悬吊术进行矫治,分析术后上睑下垂矫正效果,上睑缘弧度、重睑形成及倒睫、结膜脱垂等并发症发生情况.结果 随访观察6～18个月,平均11.6个月.术后过矫6只眼(8.5%),欠矫2只眼(2.8%).其余患者睑裂对称,上睑弧度自然,重睑形成好.3个月后无回退、复发.术后并发症包括结膜脱垂2只眼(2.8%).应用皮质类固醇激素眼药水点眼,加压包扎,结膜脱垂消失;内翻倒睫1只眼(1.4%).上睑内侧1/3灰线处缝牵引缝线牵引后矫正内翻倒睫.结论 改良额肌瓣悬吊术矫治重度上睑下垂疗效满意,效果持久稳定、安全可靠.     

额肌瓣悬吊术矫治重度上睑下垂临床观察

目的 探讨额肌瓣悬吊术矫治重度上睑下垂的临床效果.方法 局麻后于上睑重睑皱褶处切开皮肤,剪除切口下唇的一条眼轮匝肌以暴露睑板.然后于眶上缘眉弓处作一长约15～20 mm的辅助切口,于两切口之间的眼轮匝肌下作隧道.在辅助切口处直视下夹持额肌,沿额肌止端横形剪断宽约15mm,分别在皮下与额肌间及骨膜与额肌间钝性分离以游离额肌,于其两侧向上作扇形剪开制成额肌瓣,向下牵引此瓣缝合于睑板上1/3处.间断缝合重睑切口及辅助切口.术后观察5月～6年.结果 76例（92眼）全部矫正满意,外观良好,未见复发病例.结论 额肌瓣悬币术矫治重度上睑下垂方法简单,符合生理功能,手术成功率高,效果良好.     

先天性上睑下垂手术后并发症原因分析与处理

目的:探讨先天性上睑下垂术后并发症原因及治疗方法。方法:对在我院住院行先天性上睑下垂再次手术的患儿20例21眼进行观察分析并行手术治疗,追踪手术疗效。结果:再次手术原因:上睑内翻倒睫8例9眼,上睑下垂矫正不足14例14眼,上睑下垂矫正不足伴眼睑部分缺损瘘管形成1例1眼,双重睑外形不美观18例19眼。14眼行额肌瓣缝线调整术,1眼行额肌瓣悬吊术+瘘道切除眼睑缺损修复术,4眼行额肌瓣悬吊术,2眼行额肌瓣加固术。所有患儿术后追踪观察0.5～1a,效果满意。除轻度的上睑迟滞现象以外无其余并发症。结论:上睑下垂术后并发症多种多样,治疗无固定的模式,需根据具体情况进行个性化处理。术前全面检查、正确选择手术方式、提高手术技巧是减少手术并发症的关键。     

Frontalis muscle flap advancement for correction of blepharoptosis

PURPOSE: To describe a technique of frontalis muscle flap advancement to repair myogenic ptosis in lieu of a graft or suture material. METHODS: Ten ptotic eyelids in eight patients were repaired using the frontalis flap technique. Patients were selected at random by two separate surgeons; all patients had eyelid excursion measured as poor (or less than 6 mm). RESULTS: Nine of 10 ptotic eyelids were adequately corrected by the frontalis flap technique, with follow-up intervals ranging from 18 to 42 months. Adequate correction was defined as ptosis corrected within 1 mm of the fellow eyelid. Complications of frontalis advancement were few and primarily transient. CONCLUSIONS: Frontalis flap advancement is a technically simple, safe, and effective technique for the repair of myogenic ptosis. The primary advantage of frontalis muscle flap advancement over a graft or suture material that it elevates the eyelid directly by moving the insertion of the frontalis muscle into the eyelid, rather than by graft or suture material.     

Advances in the diagnosis and treatment of ptosis

PURPOSE OF REVIEW: The surgical correction of blepharoptosis, both congenital and acquired, has been intensively examined and reported on for many years. This paper reviews recent publications on basic science, evaluation, technique modifications, and innovative materials in the care of ptosis patients. RECENT FINDINGS: The frontalis suspension technique is a commonly performed surgical correction of congenital blepharoptosis, used widely in the repair of ptosis with poor levator function. The repair typically includes using either tissue such as autologous or banked fascia lata or permanent suture material. The procedure involves connecting the motor unit (frontalis muscle) and the upper eyelid. Authors have recently reintroduced the technique of a dynamic frontalis muscle flap tunneled into the eyelid that directly attaches to the tarsal plate.Patients presenting with symptomatic blepharoptosis due to disinsertion or thinning of the levator aponeurosis require surgical repair. Multiple groups have tended toward a minimally invasive approach directed specifically at the levator aponeurotic defect. Proposed advantages of a small eyelid incision (8-13 mm) include less local anesthetic and tissue distortion, less ecchymosis and edema, decreased operative times, a shortened recovery period, and improved surgical results. SUMMARY: Surgical correction of congenital blepharoptosis may be performed with autologous fascia lata, cadaveric allograft, or permanent suture material. The use of a frontalis muscle advancement flap is elegantly designed; however, its role in clinical practice remains to be defined. Advancement of the levator aponeurosis for senile blepharoptosis may be preformed via a minimally invasive small incision approach. Patients benefit with decreased operative time, edema, ecchymosis, and recovery times.     

儿童额肌瓣悬吊术中术后常见并发症及处理

目的 探讨儿童额肌瓣悬吊术中术后并发症的发生原因及相应处理措施.方法 2002年1月至2010年8月行额肌瓣悬吊术的120例(141只眼)病人临床资料进行回顾性分析.结果 发生术中并发症19只眼(13.48％),其中出血影响操作17只眼(12.06％),眶脂肪突出2只眼(1.42％);术后并发症21只眼,发生率为14.89％,其中矫正不足7只眼(4.96％),倒睫5只眼(3.55％),缝线滑脱致复发1只眼(0.71％),矫正过度1只眼(0.71％),上睑肿胀1只眼(0.71％),睑缘位置不自然3只眼(2.13%),角膜上皮脱落2只眼(1.42％),角膜溃疡1只眼(0.71％),给予相应的处理措施,治愈所有并发症.结论 术前全面准备、术中精细操作、术后及时处理是减少儿童额肌瓣悬吊手术并发症的关键.     

复发性先天性上睑下垂的发病原因和疗效分析

目的:分析先天性上睑下垂复发的原因,指导再次手术方式的选择。方法:术前了解前次手术方式,分析失败原因,根据提上睑肌肌力结合病史确定再次手术方式。以提上睑肌肌力为依据,考虑前次手术的手术方式,对于提上睑肌肌力≤4mm者均采用额肌瓣悬吊术,对于提上睑肌肌力≥6mm者,均选择提上睑肌缩短术,对于提上睑肌肌力4～6mm之间者,若前次手术是利用额肌的手术,可行提上睑肌缩短术或额肌瓣悬吊术,我们采用了额肌瓣悬吊术。结果:患者26例30眼术眼睑缘弧度无畸形,双重睑自然,上睑缘位于上方角膜缘下1～2mm,或与健眼基本对称。结论:复发性先天性上睑下垂再次手术要根据提上睑肌肌力结合病史确定再次手术方式。     

改良额肌瓣悬吊术术中术后并发症分析

目的 探讨改良额肌瓣悬吊术治疗先天性上睑下垂术中术后并发症的发生原因及处理措施.方法 回顾性分析改良额肌瓣悬吊术治疗先天性上睑下垂136例（167眼）的临床资料.结果 术中并发症14眼,发生率为8.38％,其中出血影响操作10眼（5.98％）,眶脂肪脱出3眼（1.80％）,额肌瓣撕裂1眼（0.60％）.术后并发症12眼,发生率7.19％,其中矫正过度5眼（2.99％）,矫正不足3眼（1.80％）,缝线反应致上睑瘢痕1眼（0.60％）,睑缘位置不自然1眼（0.60％）,上睑肿胀1眼（0.60％）,角膜上皮脱落1眼（0.60％）.经过施行相应的处理措施,并发症均治愈.结论 术前全面检查、提高手术技巧、术中精细操作、术后及时处理是减少改良额肌瓣悬吊术并发症的关键.     

额肌瓣悬吊术矫正重度先天性上睑下垂

目的:探讨额肌瓣悬吊术矫正重度先天性上睑下垂的临床效果。方法:对28例35眼重度先天性上睑下垂患者,施行额肌瓣悬吊术,观察分析术中、术后并发症,随访观察术后效果。结果:本组病例均矫正理想,无严重术中术后并发症发生。结论:额肌瓣悬吊术矫正重度先天性上睑下垂的手术可靠,效果满意,是治疗重度上睑下垂较可靠的手术方法。     

上睑下垂术后常见并发症的治疗

目的:探讨上睑下垂常见并发症的处理方法。方法:总结近5a来矫正上睑下垂的临床体会,对常见的并发症如矫正不足、矫正过度、暴露性角膜炎、结膜或者泪腺脱垂分别采取相应对策,尽量早期发现纠正,可以获得满意临床效果。结果:所选150例180眼上睑下垂患者中,127例患者术后上睑下垂矫正满意,双侧基本对称,无明显并发症。12例患者14眼欠矫,4例患者4眼轻度过矫,3例患者3眼结膜脱垂,1例患者1眼泪腺脱垂,3例3眼轻度睑球分离,早期予以调整后形态满意,未出现感染、血肿病例。结论:对于上睑下垂患者采用提上睑肌缩短法或者额肌瓣悬吊矫正,术中尽量准确判断,术后精心护理,严密观察,出现并发症可以早期处理以获得好的效果。     

Frontalis muscle flap advancement for jaw-winking ptosis

PURPOSE: To describe the technique and results of frontalis muscle flap advancement for correction of ptosis associated with jaw-winking. METHODS: Four cases of unilateral jaw-winking ptosis were corrected with frontalis muscle flap advancement after excision of levator muscle on the affected side. RESULTS: Three of the 4 patients achieved good results with the correction within 1 mm of the opposite eyelid. The residual asymmetry on downgaze after follow-up of 4 to 18 months ranged from 1 to 5 mm. The main complication was mild forehead hypoesthesia in 2 patients, which resolved over a period of 1 month. CONCLUSIONS: Frontalis muscle flap advancement is an effective procedure when performed unilaterally for jaw-winking ptosis. It is simple, safe, and involves a single surgical field. Eyelid lag on downgaze improves considerably over time, and the remaining asymmetry between the two eyelids is cosmetically acceptable to most patients.     

Unilateral frontalis sling for the surgical correction of unilateral poor-function ptosis

PURPOSE: To evaluate the functional and cosmetic results after frontalis sling repair for unilateral ptosis associated with either poor levator function or synkinesis. METHODS: Preoperative and postoperative photographs and records of 127 patients who underwent unilateral frontalis sling ptosis repair were retrospectively reviewed. An eyelid crease incision was used in all cases, with suturing of the sling material directly to tarsus. RESULTS: Preoperative diagnosis for all patients was either unilateral poor-function blepharoptosis or ptosis associated with levator synkinesis. Underlying causes included 75 congenital, 13 posttraumatic, 11 congenital "jaw-winking," 10 cranial nerve III palsies, 9 myasthenia gravis, 5 chronic progressive external ophthalmoplegia, and 4 congenital "double-elevator" palsies. There was a mean follow-up of 11.6 months. Twenty-eight eyelids required reoperation: 11 for undercorrection, 6 for overcorrection with keratopathy, 2 for upper eyelid crease revision, 7 for correction of poor contour, 1 for a broken sling, and 1 for removal of an infected exposed polytetraflouroethylene sling. Lagophthalmos of greater than 2 mm was noted in 18 patients, 5 of whom had persistent keratopathy requiring reoperation. No other complications were reported, except for 1 suture granuloma. Good to excellent final postoperative eyelid height was achieved in 121 patients (95%) after all surgeries and with conscious recruitment of the frontalis muscle. A large majority of patients and/or parents expressed satisfaction with the final cosmetic result and were not bothered by any asymmetric lagophthalmos in downgaze or lack of a synchronous blink. However, 19 of 25 amblyopic patients were less satisfied with passive eyelid height as they failed to recruit the ipsilateral frontalis muscle to activate the sling during binocular viewing. In 17 of these 19 patients, good to excellent eyelid height could be achieved with conscious active brow elevation. CONCLUSIONS: Unilateral sling provides good to excellent functional and cosmetic results in unilateral poor-function ptosis. However, patients with amblyopia usually require conscious effort to activate the frontalis muscle to achieve satisfactory eyelid height.