儿童先天性下睑内翻的治疗

目的 探讨儿童先天性下睑内翻的不同发病机制及对症治疗的效果.方法 102例（204眼）儿童先天性下睑内翻,年龄1岁5个月～15岁.对不同的临床表现采用不同的手术方法矫正.结果 对于下睑内翻轻度,眼球上下转动睫毛的位置不改变者,行单纯下睑穹隆皮肤3对缝线法6例（12眼）;下睑内翻轻度,向前方注视睫毛不接触眼球,眼球向下转动时睫毛接触眼球者,采用下直肌鞘离断术7例（14眼）;睑内翻中度或重度,眼球向下转动时加重者,采用下直肌鞘纤维离断联合缝线法45例（90眼）;下睑内翻中度或重度,眼球上下运动睫毛位置无改变者,采用下睑皮肤和下眼轮匝部分切除的切开法（Hotz法）42例（84眼）.单纯内眦赘皮矫正术2例（4眼）.术后随诊3个月～1年,97.05％的患眼下睑内翻得到完全矫正,2.95％的患眼内眦部有倒睫.结论 儿童先天性下睑内翻根据其临床不同的表现,采取个性化的治疗,方能达到最佳的效果.

Treatment for congenital lower lid entropion in children

Objective To investigate the pathogenesis and surgical methods of congenital lower eyelid entropion in children.Methods The study included 204 eyes of 102 cases of pediatric congenital lower eyelid entropion who were aged 1.5 to 15 years old.They accepted different surgical procedures based on their clinical manifestations.Results Twelve eyes of 6 cases with slight lower eyelid entropion and eyelash position without change when the eyeballs moved were treated by inferior fomix based suture placement.Seven cases （14 eyes） also had slight lower eyelid entropion.When they looked forward,the eyelash did not contact the cornea.They accepted inferior rectus sheath dissection.Ninety eyes （45 cases）were corrected by inferior rectus sheath dissection combined with inferior fomix bases suture placement,who had mild to severe lower eyelid entropion and lower eyelid entropion became worse when look downward.Eyelid skin resection combined with orbicularis muscle resection （Hotz methods） were performed on 42 cases （84 eyes） who had mild to severe lower eyelid entropion with the location of eyelashes would not change when they moved the eyeballs.There were 4 eyes of 2 cases only accepted epicanthoplasty.The follow up was from 3 months to 1 year after the operation.The lower eyelid entropion was completely corrected in 97.05％ of patients.Trichiasis was observed in 2.95％ of cases.Conclusion Congenital lower eyelid entropion in children should be treated by individual surgical procedures based on its pathogenesis and clinical manifestations to achieve the optimal clinical efficacy.