闫丽娟 吉昂

[摘要]目的：探讨眶隔脂肪重置联合睫毛下翻转缝合术治疗退行性下睑内翻的疗效。方法：本组共56例（74只眼）退行性下睑内翻患者，分为AB两组，A组40只眼，单纯行眼睑皮肤眼轮匝肌切除+睫毛下翻转缝合术，B组34只眼，行眼睑皮肤眼轮匝肌切除+睫毛下翻转缝合术+眶脂肪重置术，观察术后1个月、3个月、1年治愈率，复发率，有无过矫及睑外翻现象。结果：术后1个月，3个月治愈率及未愈率组间比较差异均无统计学意义（P>0.05）;术后1年B组治愈率高于A组，差异有统计学意义（P<0.05）。结论：眶脂肪重置术联合睫毛下翻转缝合术治疗退行性下睑内翻，远期复发率较低，对于有睑袋或相关美容需求患者更为合适。

[关键词]眶隔脂肪;退行性下睑内翻;翻转缝合;眼轮匝肌切除术;治愈率;远期疗效

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）01-0009-03

The Effect of Orbital Septum Fat Replacement Combined with Infraciliary Rotation Sutures in the Treatment of Involutional Lower Eyelid Entropion

YAN Li-juan，JI Ang

（Department of Ophthalmology，Beijing Haidian Hospital，Beijing 100080，China）

Abstract： Objective  To evaluate the technique of orbital septum fat replacement combined with infraciliary rotation sutures for correction involutional lower eyelid entropion. Methods  There were 56 patients （74 eyes） with involutional lower eyelid entropion. Patients were divided into two groups. Group A had 40 eyes， executed eyelid skin blepharosphincterectomy and infraciliary rotation sutures. Group B had 34 eyes， combined eyelid skin blepharosphincterectomy and infraciliary rotation sutures with orbital septum fat replacement. One month， 3 months and one year after operation， the cure rate， recurrence rate， overcorrection and ectropion were observed. Results  There was no significant difference in the cure rate and non cure rate between the two groups at one month and 3 months after operation（P>0.05）. One year after operation， the cure rate of group B was higher than that of group A， and the difference was statistically significant（P<0.05）. Conclusion  Orbital septum fat replacement and infraciliary rotation sutures for correction involutional lower eyelid entropion had lower recurrence rate， suited for obvious eyelid pouch and cosmetic requirement patients.

Key words： orbital septal fat; involutional lower eyelid entropion; rotation sutures; orbicularis oculi muscle resection; cure rate; long-term efficacy

瞼内翻指眼睑，特别是睑缘向眼球方向翻转的异常状态，睑内翻使睫毛刺激眼球引起异物感、疼痛、流泪等症状，严重者可导致角膜上皮脱落和溃疡。退行性睑内翻又称为老年性睑内翻，常见于下睑，影响因素包括眼睑水平方向松弛，眼睑缩肌变细或断裂而致下睑缩肌无力，眶隔前眼轮匝肌跨越[1]，是眼科常见的退行性外眼疾病。临床上退行性睑内翻多采用眼轮匝肌切除术、眼轮匝肌折叠缩短术、部分睑板切断术、下睑缩肌腱膜缝合法、睫毛下翻转缝合等手术治疗，术式多样[2-7]。退行性下睑内翻患者常常合并睑袋，而睑内翻手术同时矫正并存的睑袋，会增加手术成功率，同时获得外观改善[8-9]。既往睑袋手术多采取眶脂肪切除术，会导致下睑的支撑力更加减弱，后期眼眶凹陷等问题严重，过矫风险较大[10]。本研……