上睑联合筋膜鞘(CFS)治疗复发性中重度上睑下垂
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摘要
目的:探讨一种矫正中重度上睑下垂术后复发的稳定可靠的手术方法。方法:2016年1月-2017年12月,共治疗复发性重度上睑下垂16例,其中双眼10例,单眼6例,共26只眼,局麻下首先剥离出睑板组织,仔细分离前次手术瘢痕粘连组织,解剖出变性额肌组织或提上睑肌,于结膜与上睑提肌腱膜下向后上分离至上睑结膜穹窿处,见白色增厚联合腱膜鞘,6-0尼龙线将睑板悬挂缝合于联合腱膜上,再将提肌腱膜向前下方牵拉缝合于睑板上。术中调整缝挂联合腱膜及上睑提肌的位置,将上睑缘调整至合适的高度及睑缘曲率流畅。结果:随访6个月～1年,满意25只眼,1只欠满意,无明显严重并发症,轻度闭合不全在3个月内基本恢复,无角膜暴露。结论:上睑联合腱膜鞘(CFS)及上睑提肌腱膜前徒手术可以稳定有效矫正复发性中重度上睑下垂,术后闭合不全发生率低,美容效果好,复发率低。
Objective To discuss a better way for the treatment of moderate or severe recurrent blepharoptosis. Methods From January 2016 to December 2017, conjoint fascia sheath suspension was performed in 16 patients(26 eyes, one side was 6 and two side was 10) with recurrent blepharoptosis. The double eyelid line was redesigned, the scar tissue at each layer was released and dissociated, the connection of frontal muscle flap to tarsal plate was amputeted and anatomical reduction was performed. The eyelid board edge was exposed and the lower layer of the levator palpebrae superoris muscle was penetrated at the lateral position.With separation toward the fornix along the conjunctiva, the CFS was located between the former of the musical rectus superior and the elevator palpebrae superiors muscle. Ptosis was corrected by sutruing the superior alar ligament and corresponding elevator palpebral superioris aponeurosis to the upper margin of the tarsal plate with 6-0 nylon thread. Conventional suture was performed to shape the double eyelid. Success was assumed when the height of palpebral fissure measured significantly higher than before. Results All 16 cases were followed up from 6 to 24 months. Good correction was achieved in 25 eyes. In one case, satisfactory result was achieved after reoperation because of the large difference between bilateral eye. All patients were able to completely close their eyes in 3 months. Conclusion The application of conjoint fascia sheath suspension in the repair of recurrence after severe or moderate conjointal ptosis can achieve satisfactory clinical results.
Objective To discuss a better way for the treatment of moderate or severe recurrent blepharoptosis. Methods From January 2016 to December 2017, conjoint fascia sheath suspension was performed in 16 patients(26 eyes, one side was 6 and two side was 10) with recurrent blepharoptosis. The double eyelid line was redesigned, the scar tissue at each layer was released and dissociated, the connection of frontal muscle flap to tarsal plate was amputeted and anatomical reduction was performed. The eyelid board edge was exposed and the lower layer of the levator palpebrae superoris muscle was penetrated at the lateral position.With separation toward the fornix along the conjunctiva, the CFS was located between the former of the musical rectus superior and the elevator palpebrae superiors muscle. Ptosis was corrected by sutruing the superior alar ligament and corresponding elevator palpebral superioris aponeurosis to the upper margin of the tarsal plate with 6-0 nylon thread. Conventional suture was performed to shape the double eyelid. Success was assumed when the height of palpebral fissure measured significantly higher than before. Results All 16 cases were followed up from 6 to 24 months. Good correction was achieved in 25 eyes. In one case, satisfactory result was achieved after reoperation because of the large difference between bilateral eye. All patients were able to completely close their eyes in 3 months. Conclusion The application of conjoint fascia sheath suspension in the repair of recurrence after severe or moderate conjointal ptosis can achieve satisfactory clinical results.
引文
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[2]Holmstr?m H,Santanelli F.Suspension of the eyelid to the check ligament of the superior fornix for congenital blepharoptosis[J].Scand J Plast Reconstr Surg Hand Surg,2002,36(3):149-156.
[3]Holmstr?m H,Bernstr?m-Lundberg C,Oldfors A.Anatomical study of the structures at the roof of the orbit with special reference to the check ligament of the superior fornix[J].Scand J Plast Reconstr Surg Hand Surg,2002,36(3):157-159.
[4]曹仁昌.眼整形艺术[M].瘳文杰,译.台北:力大图书有限公司,2016:230-235.
[5]王振军,刘柳,王恒.联合筋膜鞘(CFS)悬吊术治疗额肌瓣悬吊术后复发重度上睑下垂[J].中国美容医学,2016,25(8):30-33.
[6]Hwang K,Shin YH,Kim DJ.Conjoint fascial sheath of the levator and superior rectus attached to the conjunctival fornix[J].J Craniofac Surg,2008,19(1):241-245.
[7]潘贰,于建刚,张胜昌.上睑翼状韧带悬吊修复额肌瓣矫正重度上睑下垂术后复发[J].中国美容整形外科杂志,2017,28(10):589-591.
[8]李欣,陆孟婷,蒋艳,等.联合筋膜鞘悬吊术治疗中重度上睑下垂[J].局解手术学杂志,2018,27(5):333-336.
[9]赵英年,葛洪刚,沈清俐.联合筋膜鞘悬吊术和额肌瓣悬吊术治疗中重度上睑下垂的疗效比较[J].国际眼科杂志,2017,17(9):1790-1792.
[10]费孝庆,廖荣丰.比较额肌瓣悬吊术和联合筋膜鞘悬吊术治疗先天性重度上睑下垂前后的眼表变化[J].临床眼科杂志,2017,25(3):273-275.
[2]Holmstr?m H,Santanelli F.Suspension of the eyelid to the check ligament of the superior fornix for congenital blepharoptosis[J].Scand J Plast Reconstr Surg Hand Surg,2002,36(3):149-156.
[3]Holmstr?m H,Bernstr?m-Lundberg C,Oldfors A.Anatomical study of the structures at the roof of the orbit with special reference to the check ligament of the superior fornix[J].Scand J Plast Reconstr Surg Hand Surg,2002,36(3):157-159.
[4]曹仁昌.眼整形艺术[M].瘳文杰,译.台北:力大图书有限公司,2016:230-235.
[5]王振军,刘柳,王恒.联合筋膜鞘(CFS)悬吊术治疗额肌瓣悬吊术后复发重度上睑下垂[J].中国美容医学,2016,25(8):30-33.
[6]Hwang K,Shin YH,Kim DJ.Conjoint fascial sheath of the levator and superior rectus attached to the conjunctival fornix[J].J Craniofac Surg,2008,19(1):241-245.
[7]潘贰,于建刚,张胜昌.上睑翼状韧带悬吊修复额肌瓣矫正重度上睑下垂术后复发[J].中国美容整形外科杂志,2017,28(10):589-591.
[8]李欣,陆孟婷,蒋艳,等.联合筋膜鞘悬吊术治疗中重度上睑下垂[J].局解手术学杂志,2018,27(5):333-336.
[9]赵英年,葛洪刚,沈清俐.联合筋膜鞘悬吊术和额肌瓣悬吊术治疗中重度上睑下垂的疗效比较[J].国际眼科杂志,2017,17(9):1790-1792.
[10]费孝庆,廖荣丰.比较额肌瓣悬吊术和联合筋膜鞘悬吊术治疗先天性重度上睑下垂前后的眼表变化[J].临床眼科杂志,2017,25(3):273-275.