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。

Clinical characteristics and emergency surgical method with 60 full-thickness eyelid lacerations

Objective To investigate the causeistics, clinical characteristics, emergency surgical method of full-thickness eyelid laceration. Design Retrospective case series. Participants 60 patients （60 eyes） with full-thickness eyelid laceration in Beijing Tongren Hospital. Methods Patients were performed a detail eye examination, including detailed history inquiry. The full-thickness laceration of eyelid was operated with methods of vertical mattress suture, horizontal mattress suture or near-far far-near suture. If combined with lachrymal duct disruption, rupture of the medial or temporal cantus ligament and muscles elevator, defect of the skin or tarsal plate, in addition to suture full-thickness laceration of eyelid, we repaired the disruption of lachrymal duct, and the medial or temporal eantus ligament and so on. Main Outcome Measures Morphology of eyelid, position of eyelid and movement of eyelid. Results The main causes of full-thickness eyelid laceration in Beijing Tongren Hospital were traffic accidents, blunt trauma, fallen accidents and animal bites. All 60 eases were observed for 6-12 months after surgery. Most patients with full-thickness eyelid laceration gained excellent recovery for both the appearance and function. 38 cases （95%） with lacrimal duct disruption were re-connected. Conclusions The leading causes of full-thickness eyelid laceration are traffic accidents and blunt trauma. In most cases the prompt, correct repair of full-thickness eyelid laceration can have better recovery of both the appearance and the movement of eyelid. It is also important for secondary eyelid reconstruction in some severe cases.