过睑板下缘连续缝合内固定联合眶隔整复治疗下睑赘皮

目的 评价应用皮肤、眼轮匝肌部分切除＋过睑板下缘连续缝合内固定术,或联合眶隔整复术治疗下睑赘皮的疗效,并分析相关的解剖结构特点.方法 回顾性病例系列研究.回顾分析2006年4月至2010年4月于我院诊断为下睑赘皮并行皮肤、眼轮匝肌部分切除＋过睑板下缘连续缝合内固定术,或联合眶隔整复术的14例患者的临床资料,患者年龄为13～30岁,均为双眼发病.所有患者均采用这种改良术式,其中8例还同时行眶隔整复术.术后随访4个月～4年,平均随访13个月.观察手术疗效：下睑赘皮及倒睫是否完全矫正,症状是否缓解,有无并发症出现及是否复发等.结果 所有患者均行皮肤、眼轮匝肌部分切除＋过睑板下缘连续缝合内固定术,其中8例（57%）术中发现眶隔附着点较高,同时行眶隔整复术.术中发现解剖特点为：所有患者均有下睑皮肤、皮下组织、眼轮匝肌向睑缘部堆积,10例睑缘部眼轮匝肌肥厚,8例眶隔附着点较高.术后27眼（96%）完全矫正,1眼（4%）残留轻度下睑赘皮.所有患者术后均无复发及并发症.结论 皮肤、眼轮匝肌部分切除＋过睑板下缘连续缝合内固定术是治疗下睑赘皮的有效方法,对于眶隔附着点较高者,需同时行眶隔整复术.

A modified procedure for epiblepharon in youths

Objective To evaluate the efficacy of either a partial excision of the skin and orbicularis muscle with a running suture to the tarsal muscle, or a combined septum repair for epiblepharon in children and youths, and to analyze the anatomic factors. Methods This study was a retrospective review of 14 patients, 13 to 30 years of age, who were diagnosed with epiblepharon on the lower eyelids and had undergone either partial excision of the skin and orbicularis muscle with a running suture to the tarsal muscle, or a combined septum repair in our hospital (April 2006 to April 2010). They all involved both eyes. All cases were followed up for 4 months to 4 years after surgeries, average 13 months. The effects, complications and recurrence of the modified procedures were investigated. Results All patients underwent partial excision of the skin and orbicularis muscle with a running suture to the tarsal muscle, and the 8 patients (57%) who had a higher septum attachment onto the tarsus had the combined septume repair. All 14 patients had skin and orbicular oculi muscle fold, pushing the pretarsal oculi muscle and skin onto the eyelid margin; 10 patiens had hypertrophy of the orbicular oculi muscle; and 8 patients had a higher septum attachment onto the tarsus. Epiblepharon and trichiasis were corrected completely in 27 eyes (96%) and remind mild epiblepharon in 1 eye (4%), and no severe complications or recurrence were observed.Conclusion The modified operation involving partial excision of the skin and orbicularis muscle with a running suture to the tarsal muscle is simple and effective without severe complications. Patients with a higher septum attachment must have the combined septum repair.