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

摘要

Objective To investigate the clinical effect of conjoint fascial sheath(CFS) suspension to correct the complications caused by the frontal muscle lfap suspension surgery in the treatment of eyelid ptosis. Methods A series of 213 patients over a 6-year period underwent 339 eyelid procedures to repair complications following traditional frontal muscle lfap suspension surgery. All eyelids were corrected with the authors' suspension technique by which CFS located between levator and superior rectus was brought forward and sutured to the tarsus to raises the eyelid. Results Of the 339 cases, 282 eyelids were raised with 83.2%normalization, 15.0%(51) improvement, and only 1.8%(6) eyelids showed no changed. 29 of the favorable cases achieved satisfactory advancement for the ptosis by corrective procedure through early revision surgery.4 of the 6 unsuccessful cases were normalized and the other 2 were improved after the revision surgery. No other complications were observed. Conclusion CFS is a dynamic suspension technique by which the elevating motion of the physiologic eyelids cloud be reconstructed. Correction of the complications following frontal muscle lfap suspension surgery by CFS is simple to execute, measurable during surgery, and easy to adjust, and offers high predictability in its result.%目的：探讨额肌瓣悬吊术治疗上睑下垂手术失败后，利用联合筋膜鞘（CFS）悬吊手术再次手术矫正的临床效果。方法：2008年12月-2014年12月6年间，利用该技术治疗额肌瓣悬吊术后复发上睑下垂213例共339只眼，单侧87例，双侧126例，随访1年到5年。在局部麻醉下，将睑板上缘与位于上直肌与提上睑肌之间的联合筋膜鞘缝合固定以提高上眼睑的高度。结果：其中治愈282只眼，占83.2%，改善51只眼，占15.0%。无效6只眼，占1.8%。对29只改善眼进行了术后二次调整手术，均达到治愈标准；对6只无效眼进行了调整手术，4只达到治愈标准，2只为改善，所有术后二次调整时间最短为术后5d，最长为术后6个月。结论：应用联合筋膜鞘悬吊技术是一种符合生理抬眼运动的带动力的悬吊手术。CFS治疗额肌瓣悬吊术后复发上睑下垂，具备术中可调整，手术结果高度可预测的优点。