阶梯性手术矫正上睑凹陷临床应用研究.docVIP

阶梯性手术矫正上睑凹陷临床应用研究 　　[摘要]目的：探讨矫正上睑凹陷的阶梯性手术方式及疗效。方法：对32例上睑凹陷者，采用切开法重睑成形术常规切口，剪开眶隔，保留眶隔脂肪包膜的完整性，首先松解眶隔脂肪包膜与提上睑肌腱膜的纤维连接，对于无上睑下垂者，PARK法行提上睑肌腱膜与切口下肌皮瓣的固定；对于合并轻中度上睑下垂者采用上睑提肌腱膜修补术、腱膜折叠术、缩短术或联合术式；然后将眶隔脂肪重置到凹陷区，或者联合自体颗粒脂肪注射到凹陷区的眶隔脂肪包膜内；最后将自体颗粒脂肪注射到眶隔前脂肪垫（又称肌下纤维脂肪组织）和（或）眼轮匝肌后脂肪垫。常规缝合切口。结果：32例（64只眼）中24例（48只眼）获6～24个月随访，平均随访10个月，上睑凹陷消失，重睑线流畅，双侧对称，眼部外观接近美学标准，无并发症。结论：对于上睑凹陷患者，采用阶梯性手术方式：恢复上睑提肌腱膜与睑板的正常连接和张力强度；使眶隔脂肪的位置和容量达到解剖结构上的恢复；重塑眶隔前脂肪垫又称肌下纤维脂肪组织和眼轮匝肌后脂肪垫的容量，在恢复上睑的解剖结构、运动功能、美化眼外形等方面取得良好的手术效果。 　　[关键词]阶梯性手术；上睑凹陷；上睑下垂；眼轮匝肌后脂肪垫；眶隔前脂肪垫 　　[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2015）20-0020-04 　　Abstract： Objective To explore the methods and effect of step operation in the correction of sunken upper eyelid. Methods Blepharoplasty incision was used in 32 cases.Keeping the orbital fat sac intact after orbital septum was opened.Firstly，the conjunction was released between the orbital fat sac and levator aponeurosis，PARK blepharoplasty was used for the people without blepharoptosis；levator aponeurosis restoration，plecation，shorten or combination was used in mild to moderate blepharoptosis.Then，obital fat was repositioned to the depression region，or autologous fat was injected into the orbital fat sac.Lastly，autologous fat was injected into the preseptal fat（submuscular fibroadipose tissue，SMFAT）and（or）retro-orbicularis oculi fat（SOOF）.And the incision was closed routinely. Results Of 32 cases（64 eyes），24 cases（48 eyes）were available for 6 to 24 months follow-up（average，10 months）with satisfactory aesthetic and functional outcomes. Conclusions The step operation including reconstructing the conjunction of levator aponeurosis and tarsal plate，repositioning the location and volume，restoring the volume of PSF and SOOF，plays an important role for the correction of sunken upper eyelid. 　　Key words：step operation；sunken upper eyelid；blepharoptosis；retro-orbicularis oculi fat（SOOF）； submuscular fibroadipose tissue（SMFAT） 　　上睑凹陷指上眼睑和眶上缘之间的凹陷局域，有时伴有上睑下垂现象。上睑凹陷使人呈现双目憔悴、疲惫苍老之状。目前临床上矫正上睑凹陷主要以自体颗粒脂肪移