肖翔辕,黎冻,周翔,莫海雁,韦洁

[摘要]目的：探讨在眼袋整复术中合理有效地眶脂切除麻醉方法。方法：在打开眶隔或眼睑囊筋膜前，采用不同于眼科的特殊的球周麻醉，既有效的麻醉了下睑眶脂感觉神经，又增加眶脂容积压力，有助于眶隔脂肪的释放切除。结果：观察78例（156眼），其中行皮肤入路者56例，结膜入路者22例。取脂过程中患者疼痛减轻，取脂更为简便。随访6个月～1年，77例未见眼袋复现，1例有轻微复眼袋复现。结论：在眼袋整复术中，采用特殊的球周麻醉方法应用于眶脂切除效果良好。

[关键词]眼袋整复术；眶隔脂肪；球周麻醉

[中图分类号]R622[文献标识码]A[文章编号]1008-6455（2012）04-0556-03

Jointapplication of retrobulbar block anesthesia and peribulbar tumescent anesthesia in lower blepharoplasty

XIAO Xiang-yuan,LI Dong,ZHOU Xiang,MO Hai-yan ,WEI Jie

(The Center of Plastic and Aestheti Surgery,Fiist Affiliated Hospital of Guangxi Medical University,Nanning 530007,Guangxi,China)

Abstract:ObjectiveTo introduce an effective anesthesia technique for orbital fat removal in lower blepharoplasty.MethodsBefore openingorbital septum or capsulopalpebral fascia, with the application of special peribulbar anesthesia differentiated from traditional peribulbar tumescent anesthesia in lower blepharoplasty,the sensory nerve of orbital fat were effective anesthetized,and the volume pressure in orbit rose. Orbital fat could be removal more easily.Results78 cases (156 eyes) were observed,of which 56 skin incisal cases and 22 transconjunctival cases. The pain when orbital fat were removed was alleviated.And orbital fat removal was facilitated. After 6～12 months'follow-up,no eye bag reappeared except 1 case.ConclusionsTheapplication of special peribulbar anesthesia in lower blepharoplasty could make orbital fat removal more effective.

Key words:blepharoplasty; orbital fat; peribulbar anesthesia

下睑眼袋整复术是眼部美容手术中最常见的的一类手术，眼袋根据其类型不同选择的术式有所不同，但绝大多数眼袋整复手术的过程当中都涉及到去除部分眶隔脂肪，我科在去除眶脂的过程中采用一种特殊的眶脂麻醉的方法，效果良好，现报道如下。

1临床资料

2007年7月～2008年2月行下睑眼袋整复者78例（共156眼），其中行皮肤入路者56例，结膜入路者22例。女性76人，男性2人，年龄20～56岁，平均年龄41岁，临床随访6个月～1年。

2手术方法

2.1 肿胀麻醉液：1%利多卡因（肾上腺素1∶20万）溶液。

2.2 手术过程

2.2.1 皮肤入路眼袋整复术中应用方法（如图1）：按常规皮肤入路方法切开皮肤显露眼轮匝肌后，用手触及眶下缘、眶外缘、泪前嵴等解剖结构位置。以40mm长5号针头为注药针：①先以眼裂正中线贴下眶缘处的眼轮匝肌表面为进针点，与法兰克福平面成60°角，平行于矢状面进针，进针过程遇眶下壁密质骨的抵抗感后，稍减少与法兰克福平面所成角度，使针贴下眶壁平面走行，总进针深度约1cm回抽针芯未见回血后注入1ml麻醉用药；……