先天性上睑下垂379例治疗体会

目的 应用不同术式治疗先天性上睑下垂,并对手术效果及其并发症进行评价.方法 自2002年6月至2007年10月间,共收治先大性上睑下垂患者379例(460只眼).其中重度上睑下垂300例(381只眼),中度上睑下垂47例(47只眼),轻度上睑下垂32例(32只眼).行阔筋膜悬吊术196例(246只眼),额肌瓣悬吊术104例(135只眼),提上睑肌缩短术47例(47只眼),提上睑肌腱膜折叠术32例(32只眼).结果 术后满意率为94.6%,好转率为5.0%,总有效率为99.6%.其中阔筋膜悬吊术手术满意率为91.9%,额肌瓣悬吊术满意率为95.5%,提上睑肌缩短术满意率为95.7%,提上睑肌腱膜折叠术满意率为96.9%.手术后有50只眼(10.9%)出现各种并发症,主要有额部血肿、暴露性角膜炎、矫正不全和上穹隆结膜脱垂,经相应处理后均好转.结论 对于提上睑肌无力的重度上睑下垂患者,采取阔筋膜悬吊术或额肌瓣悬吊术治疗,术后重睑自然,远期外观效果较好.提上睑肌力较好的轻度上睑下垂患者宜采取提上睑肌手术,术后重睑弧度自然,并发症少,是较理想的治疗方法.

The surgical treatment of 379 cases of congenital blepharoptosis

Objective To investigate the various surgical techniques and their effects for correcting different types of blepharoptosis.Methods From June 2002 to October 2007,460 eyes of 379 eases patients with congenital blepharoptosis were received the surgical treatment.The patients with severe blepharoptosis were 300 cases(381 eyes),the patients with moderate blepharoptosis were 47 cases(47 eyes)and the patients with mild blepharoptosis were 32 cases(32 eyes).The surgical techniques included fascia lata sling with 196 cases(246 eyes),frontalis muscle flap suspension with 104 cases(135 eyes),superior levator muscle shortening with 47 cases(47 eyes)and superior levator aponeurosis folding with 32 cases(32 eyes).Results The satisfactory rate of the operations was 94.6%,5.0% patients were obtained better results,and the total effective rate was 99.6%.The satisfactory rates of fascia lata sling,frontalis muscle flap suspension,superior tarsal muscle resection and superior levator aponeurosis folding were 91.9%,95.5%,95.7% and 96.9% respectively.After the operations,50 eyes(10.9%)had some complications,mainly were bleeding,exposure keratitis,undercorrection and prolapse of upper conjunctival tissues.After the proper treatment,the complications were recovery.Conclusions For the patients with severe blepharoptosis and weakness of superior tarsal muscle,the fascia lata sling or frontalis muscle flap suspension could get good long-term effects and natural lid contour.For the patient with moderate or mild blepharoptosis,the superior tarsal muscle resection or superior levator aponeurosis folding was the ideal operation and could get excellent postoperative lid contour,and the postoperative complications were rare.