上睑下垂手术治疗500例

目的 探讨不同种类上睑下垂的手术治疗方法和效果。方法 对500例（620只眼）上睑下垂的手术治疗进行了回顾性总结。上睑下垂的种类包括先天性、神经源性、肌源性、外伤性、机械性和老年性。手术方法包括提上睑肌缩短术、提上睑肌腱膜瓣一额肌吻合术、Whitnall韧带悬吊术、弗．盖氏术、提上睑肌，腱膜修补术和改良Hotz术。结果 总体手术成功率为90．3％（560／620只眼）。疗效不满意的60只眼中过矫5只，欠矫55只（合并睑畸形4只，睑内翻6只，睑外翻2只）。提上睑肌缩短术治疗轻、中度先天性上睑下垂的手术成功率为93．8％。提上睑肌缩短术和提上睑肌腱膜瓣-额肌吻合术治疗重度先天性上睑下垂的手术成功率分别为72．4％和100％。Whitnall韧带悬吊术治疗复发性先天性上睑下垂的手术成功率为90％。弗-盖氏术、Whitnall韧带悬吊术和提上睑肌腱膜瓣-额肌吻合术治疗神经源性和肌源性上睑下垂的手术成功率分别为41．6％、80％和90％。提上睑肌，腱膜修补术治疗外伤性和老年性上睑下垂的手术成功率分别为94．7％和100％。改良Hotz术治疗机械性上睑下垂的手术成功率为93．3％。结论 根据上睑下垂的种类和程度选择适宜的手术方法和完善手术技巧是提高手术成功率的关键。

Surgical management of blepharoptosis: a report of 500 cases

OBJECTIVE: To investigate the various surgical techniques and their results for different types of blepharoptosis. METHODS: 620 eyes of 500 cases with blepharoptosis who underwent surgical treatment were retrospectively analyzed. The patients were diagnosed as congenital, neurogenic, myogenic, traumatic, senile and mechanical ptosis. The used techniques included resection of levator muscle, anastomosis of frontalis muscle and levator aponeurosis, Whitnall's ligament sling, Fridenwald- Guyton's frontalis muscle fixation, levator apoeurosis reconstruction, modified Hotz's tarsectomy. RESULTS: The overall success rate was 90.3% (560/620). 60 eyes with unsatisfactory result showed overcorrection in 5 eyes and undercorrection in 55 eyes in which the patients also suffered from combined eyelid deformities in 4 eyes, entropion in 6 eyes and ectropion in 2 eyes. The success rate of resection of levator muscle for the mild and moderate congenital ptosis was 93.8%. The success rates of resection of levator muscle and anastomosis of levator aponeurosis and frontalis muscle for the severe congenital ptosis were 72.4% and 100% respectively. The success rate of Whitnall's ligament sling for the recurrent congenital ptosis was 90%. The success rates of Fridenwald-Guyton's frontalis muscle fixation, Whitnall's ligament sling and anastomosis of levator aponeurosis and frontalis muscle for the neurogenic and myogenic ptosis was 41.6%, 80% and 90% repectively. The success rates of levator apoeurosis reconstruction for the traumatic and senile ptosis were 94.7% and 100%, respectively. The success rate of modified Hotz' tarsectomy for the mechanical ptosis was 93.3%. CONCLUSIONS: The key point for successful correction of ptosis is the selection of the right indication for each technique depended on the type and severity of the ptosis. The technique skill is also very important.