不同手术操作在先天性重度上睑下垂患儿中的疗效比较

目的：对比额肌瓣剪开与不剪开额肌腱膜瓣悬吊术在先天性重度上睑下垂患儿中的治疗效果。方法：回顾性研究2013－05／2015－10在我院接受治疗的44例54眼先天性重度上睑下垂患儿的临床资料。根据手术操作方式的不同将入选者分成对照组（额肌瓣两侧不剪开）和观察组（额肌瓣两侧剪开），每组22例27眼。比较两组患儿的基线资料、术后随访情况、眼睑闭合情况以及并发症发生情况。结果：两组患儿的基线资料无统计学差异（ P＞0．05）。术后1、6 mo时，两组患儿的正矫率、欠矫率及过矫率均无统计学差异（P＞0．05），但观察组患儿在术后1、6mo的上睑活动度均明显高于对照组（ P＜0．05）。术后1、6 mo时，两组患儿闭合不全情况均无统计学差异（P＞0．05），但对照组眼睑自然闭合时的睑裂高度明显高于观察组（P＜0.05）。术后1mo，对照组有2眼额部感觉异常，观察组有3眼；术后6mo，对照组额部感觉异常者2眼，观察组为3眼，术后均未发生暴露性角膜炎、睑缘畸形、感染、血肿以及复视等一系列并发症。结论：额肌瓣剪开与不剪开的总体治疗效果相似，但剪开额肌瓣可以使眼睑上睑活动度增加、眼睑闭合情况得以改善，值得推广。

Comparison of efficacy of different surgeries for congenital severe ptosis

AIM: To comparatively analyze the efficacy and clinical value of cutting frontal muscular slap or not during frontalis aponeurosis flap suspension in treating congenital severe ptosis.

METHODS: Clinical data of 44 children(54 eyes)with congenital severe ptosis treated in our hospital from May 2013 to October 2015 was retrospectively analyzed. Children included were divided into two groups according to the different ways of operation, observation group(cutting frontal muscular slap)and control group(without cutting frontal muscular slap), 22 cases(27 eyes)in each group. The general information, postoperative follow-up, eyelid closure and complication occurrence in two groups were compared.

RESULTS: The general information of the two groups had no statistical difference(P>0.05). After 1, 6mo, the cosmetic correction rate, the rate of overcorrection, and the rate of under correction in two groups had no statistical difference(P>0.05), but the activity of upper eyelid in observation group was bigger than that in control group(P<0.05). After 1, 6mo, the incomplete closure in two groups had no statistical difference(P>0.05), but eyelid fissure height in natural closed eyelids in control group was higher than that in observe group(P<0.05). After 1mo, 2 eyes in control group were with abnormal feelings in frontal part, and 3 eyes in observation group. After 6mo, 2 eyes in control group were with abnormal feelings in frontal part, and 3 eyes in observation group. There were no complications such as exposure keratitis, eyelid margin deformity, infection, hematoma, and diplopia in two groups.

CONCLUSION: The total therapeutic effects of two different surgery procedures in treating severe congenital ptosis are quite similar. The surgery with cutting frontal muscular slap could improve the activity of upper eyelid and postoperative eyelid closure.