李杰 刘竟慧 张蕾 李雨

[摘要]目的：探討三瓣吻合矫正术对重度上睑下垂患者美学情况及眼睑生理功能的影响。方法：选取笔者医院2016年12月-2018年12月收治的重度上睑下垂患者作为研究对象，根据摸球法分为对照组和观察组，各30例。对照组接受提上睑肌缩短、翼状韧带悬吊治疗，观察组接受三瓣吻合矫正术治疗。观察两组患者眼睑生理功能变化、面部美学比例改变、并发症及美学评分情况。结果：两组总有效率均较高，组间比较差异无统计学意义（P>0.05）;但观察组显效率优于对照组，差异有统计学意义（P<0.05）。术前两组上睑活动度及眼睑自然闭合时睑裂高度比较差异无统计学意义（P>0.05）;术后观察组上睑活动度高于对照组[（5.2±0.3）mm vs（4.8±0.4）mm]，眼睑自然闭合时睑裂高度低于对照组[（1.5±0.3）mm vs（2.0±0.4）mm]，差异有统计学意义（P<0.05）。治疗3个月后，观察组双睑高度对称评分[（2.53±0.32）]分、上睑轮廓评分[（2.49±0.23）分]、重睑形成效果评分[（2.70±0.15）分]高于对照组[（2.25±0.39）分、（2.28±0.31）分、（2.54±0.24）分]，差异有统计学意义（P<0.05）。3个月后观察组ΔL1/L2为（0.05±0.02），低于对照组的（0.09±0.03），差异有统计学意义（P<0.05）。术后3个月内对照组发生1例睑外翻，1例感染;观察组发生1例感染，1例血肿，两组并发症发生率比较差异无统计学意义（P>0.05）。结论：三瓣吻合矫正术治疗重度上睑下垂疗效好，可显著改善患者美学效果及眼睑生理功能。

[关键词]三瓣吻合矫正术;上睑下垂;重度;美学;眼睑;生理功能

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）04-0011-03

Observation on Aesthetic Effect of Three-valve Anastomosis Correction Surgery in the Treatment of Severe Blepharoptosis

LI Jie，LIU Jing-hui，ZHANG Lei，LI Yu

（Department of Ophthalmology，Fuyang People's Hospital，Fuyang 236000，Anhui，China）

Abstract： Objective  To investigate the effect of three-valve anastomosis correction on the aesthetic situation and physiological function of eyelid in patients with severe blepharoptosis. Methods  The patients with severe blepharoptosis who were admitted to our hospital from December 2016 to December 2018 were selected as the research object. They were divided into the control group and the observation group， 30 cases each according to the touch ball method. The control group received levator palpebral muscle shortening and pterygium ligament suspension treatment， and the observation group received three-valve anastomosis correction. The changes of eyelid physiological function， facial aesthetic ratio， complications， and aesthetic score of the two groups of patients were observed. Results  The total effective rates of the two groups were higher， and there was no significant difference between the two groups（P>0.05）. But the effective rate of the observation group was better than that of the control group， the difference was statistically significant（P<0.05）. There was no significant difference in upper eyelid activity and eyelid fissure height between the two groups before operation（P>0.05）. The upper eyelid activity of the observation group after the operation was higher than that of the control group [（5.2±0.3）mm vs （4.8±0.4）mm， P<0.05]. The eyelid fissure height was lower than that of the control group when the eyelid was closed naturally[（1.5±0.3）mm vs （2.0±0.4）mm， P<0.05]. After 3 months of treatment， the observation group's double eyelid height symmetry score ， upper eyelid outline score and double eyelid formation effect score [（2.53±0.32）， （2.49±0.23）， （2.70±0.15）] were higher than those of the control group [（2.25±0.39）， （2.28 ±0.31）， （2.54±0.24）， P<0.05]. After 3 months， the ΔL1/L2 of the observation group was （0.05±0.02）， which was lower than that of the control group （0.09±0.03， P<0.05）. Within 3 months after surgery， one case of blepharoptosis and one case of infection occurred in the control group， and one case of infection and one case of hematoma occurred in the observation group. There was no significant difference in the incidence of complications between the two groups （P>0.05）. Conclusion  The three-valve anastomosis correction surgery has a good curative effect on severe blepharoptosis， and can significantly improve the patient's aesthetic effect and eyelid physiological function.

Key words： three-valve anastomosis correction surgery; blepharoptosis; severe; aesthetics; eyelid; physiological function

上睑下垂不仅遮盖瞳孔，还影响面部美观及视觉发育。重度上睑下垂可造成剥夺性弱视，手术是其重要治疗手段[1]。目前上睑下垂矫正手术方式多样，临床尚无标准术式。既往研究认为，在重度上睑下垂患者中，传统提上睑肌缩短矫正术的临床效果不满意[2]，临床仍需探索合适手术方法。三瓣吻合矫正术是最近发展的上睑下垂矫形新技术[3]，但相关的报道较少，对于手术的效果及安全性仍待进一步临床研究，故本研究探讨三瓣吻合矫正术对重度上睑下垂患者美学情况及眼睑生理功能的影响，为临床治疗提供依据。