史俊虎 刘杉 刘兆川

[摘要]目的：探讨联合筋膜鞘+提上睑肌复合瓣悬吊治疗先天性重度上睑下垂的临床效果。方法：选取2017年9月至2019年3月于河北省眼科医院住院的先天性重度上睑下垂患者205例248眼，随机分为三组，分别应用联合筋膜鞘+提上睑肌复合瓣悬吊术（CFS+L复合瓣悬吊组）、联合筋膜鞘悬吊术（单纯CFS悬吊组）、额肌瓣悬吊术（额肌瓣悬吊组）加以矫正;随访6个月，比较三组患者正矫率、上睑回退率、上睑活动范围及眼睑闭合不全情况、并发症发生率和患者满意度。结果：CFS+L复合瓣悬吊组较其他两组有更高的正矫率，CFS+L复合瓣悬吊组及单纯CFS悬吊组术后较额肌瓣悬吊组有更好的上睑活动度、眼睑闭合不全状态较轻、并发症发生率较低，患者满意度较高;CFS+L复合瓣悬吊组较单纯CFS悬吊组术后上睑回退率低、具有更好的稳定性;差异均有统计学意义（P<0.05）。结论：联合筋膜鞘+提上睑肌复合瓣悬吊术矫正先天性重度上睑下垂具有治愈率高、效果更加稳定的特点，是一种符合眼睑活动生理学特点的动态术式。

[关键词]联合筋膜鞘+提上睑肌复合瓣悬吊术;联合筋膜鞘悬吊术;额肌瓣悬吊术;先天性重度上睑下垂;上睑回退;眼睑闭合不全

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2020）04-0023-05

Abstract： Objective  To explore the clinical effect of combined fascial sheath and levator palpebrae muscle composite flap suspension for congenital severe blepharoptosis. Methods  248 eyes of 205 patients with severe congenital ptosis were collected in HeBei Eye Hospital from September 2017 to March 2019， they were divided into three group randomly and treated by combined fascial sheath and levator palpebrae muscle composite flap suspension， combinatied fascial sheath suspension and frontalis muscle flap suspension respectively. The correction rate， the upper eyelid retraction rate， the range of upper eyelid movement， the condition of incomplete closure of eyelid， the incidence of complications and patients' satisfaction were compared among the three groups six months after operation. Results  Combined with fascia sheath and levator palpebrae superior compound flap had higher correction rate than the other two groups. It has better upper eyelid mobility， less hypophasis， less complications and higher patient satisfaction. The rate of upper eyelid retraction in CFS+L group was lower than that in CFS group. The differences were statistically significant（P<0.05）. Conclusion  Combined fascial sheath and levator palpebrae muscle composite flap suspension has more cure rate and stability in treating severe congential ptosis， it is a  dynamic surgical method that suit for the physiological characteristics of eyelid movement.

Key words： combined fascial sheath and levator palpebrae muscle composite flap suspension; combined fascial sheath suspension; frontalis muscle flap suspension; congenital severe blepharoptosis; upper eyelid retraction; lagopthalmus

重度上瞼下垂是一种严重的上眼睑运动障碍疾病，不仅严重影响患者的容貌，而且影响患者视功能[1]。额肌瓣悬吊术是在过去临床上矫正重度上睑下垂较常用的手术方法，虽能有效提升上睑缘位置，因术后易出现上睑活动度差、外观呆板、睑球分离、上睑板前组织臃肿[2-5]，尤其单眼患者术后支配神经的改变，更造成双眼睁眼的协同性被打乱;导致患者对手术效果满意度下降。……