3种术式治疗重睑术后及甲状腺眼病并发上睑退缩的疗效分析

目的探讨3种术式上睑退缩的疗效。方法重睑术后及甲状腺眼病并发上睑退缩患者15例分为A、B、C组，A组5例9只眼采用A型肉毒杆菌毒素注射治疗，B组5例10只眼采用上睑提肌中央腱膜切断术矫正，C组5例9只眼采用上睑提肌和MOiler肌（穆勒氏肌）延长术矫正上睑退缩，观察3种术式的疗效。结果A组注射A型肉毒杆菌毒素72h后，5例（9眼）上睑退缩外观明显改善，维持4～6个月后恢复至以前未注射时状态；B组上睑提肌中央腱膜切断术，术后睑外形自然，睑闭合自然，其中有2例复发；C组上睑提肌一穆勒氏肌延长术，术后随访3～24个月效果满意，术后无复发和并发症。结论3种治疗上睑退缩的方法对静止期上睑退缩均有效。采用A型肉毒杆菌毒素方法简便，疗效可靠，但持续时间较短，需反复注射；采用上睑提肌中央腱膜切断术操作简单，但不易正确量化且回缩略多；上睑提肌-穆勒氏肌延长术方法较简便，疗效可靠，并发症少。

Three methods of surgical treatment for upper eyelid retraction

objective To explore a reasonable treatment for upper eyelid shrinking. Methods All 15 patients with upper eyelid retrac-tion were divided in group A, group B and group C. Group A with 9 eyes received botulinum toxin type A, group B with 10 eyes were corrected by central aponeurosis disinsertion, group C with 9 eyes upper eyelid were corrected by the lengthening of the levator muscle and Müller＇ s muscle. And the data was summarized and analyzed. Results Five cases （9 eyes） with upper eyelid shrinking obviously were improved 72 h after injecting botulinum toxin type A,but the eyelids returned to previous states 4 - 6 months later. The shape of postoperative eyelid was good and the eyelids structure was natural in group B, recurrence was in 2 cases. Patients in group C had satisfactory results. And there was no recurrence and complications after 3 - 24 months of follow-up. Condusion The three treatments have effect on upper eyelid shrinking at quiescence phase. The method of injecting botulinum toxin type A is simple,with reliable curative effect and short duration, while it was nee-ded repeated injections. The method of central aponeurosis disinsertion is simple but difficult to quantify properly. The lengthening of the leva-tot muscle is not only simple but also with reliable effect and less comolications.