改良式额肌腱膜瓣悬吊术矫正儿童重度先天性上睑下垂

摘要

目的:探讨改良式额肌腱膜瓣悬吊术矫治儿童重度上睑下垂的长期临床疗效.方法:回顾性分析2009-01/2011-12在我科收治的儿童重度上睑下垂患者83例114眼,采用改良式扇形额肌腱膜瓣悬吊术进行矫治,分析术后上睑下垂矫正效果和上睑缘弧度、重睑形成及倒睫、结膜脱垂等并发症发生情况.随访观察5a.结果:术后第5a,矫正满意和基本矫正者共有84眼(73.7％),部分矫正30眼(26.3％),手术效果满意.术后并发症包括倒睫4眼(3.5％),其中3例3眼上睑内侧1/3灰线处缝牵引缝线牵引1wk后消失,1例1眼行二次手术;结膜脱垂2眼(1.8％),应用皮质类固醇激素眼药水点眼,加压包扎1wk后结膜脱垂均消失;术后无1例发生暴露性角膜炎、眼睑外翻、睑球分离、眼睑成角畸形、血肿形成、感染等并发症.术后上睑回退和外侧重睑皱襞消失是长期随访最常见的问题.结论:改良式额肌腱膜瓣悬吊术矫治儿童重度上睑下垂长期疗效满意,效果持久稳定,安全可靠.%AIM:To investigate the long-term clinical effect of modified frontalis tendon flap suspension in the treatment of severe blepharoptosis in children.METHODS:A total of 83 cases (114 eyes) of modified frontalis tendon flap suspension for children severe blepharoptosis correction were analyzed between January 2009 to December 2011 for the efficacy and complications of this surgery.Follow-up observation for 5a.RESULTS:In the fifth year after operation,there were 84 eyes (73.7％) with correction and satisfactory correction,30 eyes (26.3％) were corrected,and the operation was satisfactory.Postoperative complications included 4 eyes (3.5％) of inverted eyelashes,of which 3 eyes were given suture traction at 1/3 interior of the gray line,1wk later inverted eyelashes disappeared,1 eye of secondary surgery.Conjunctival prolapse was in 2 eyes (1.8％),the application of corticosteroids eye drops,pressure bandage were used for 1 wk and conjunctival prolapse disappeared.There was no recurrence of keratitis,eyelid ectropion,septum separation,eyelid angular deformity,hematoma formation,infection and other complications.Postoperative retrograde retrogression and lateral eyelid folds disappear were the most common problems of long-term follow-up.CONCLUSION:The study shows that this surgical technique is a satisfied method to treat severe blepharoptosis and predictable with few complications.