柴剑 张艳 王莹

[摘要]目的：探討两种不同固定策略的重睑成形术对先天性单睑就医者术后形态美观度的影响。方法：选取就诊的先天性单睑就医者96例，随机分为A组和B组，每组48例。A组行眼轮匝肌-上睑提肌腱膜固定重睑成形术，B组行皮肤-上睑提肌腱膜固定重睑成形术。观察术前和术后6个月时的睑裂水平长度、睑裂垂直高度、睫毛上翘度、睫毛暴露长度;术后1周时切口痕迹、睁眼闭眼自然度、上睑提肌力量;术后即刻、术后1周、术后1个月时的术区肿胀程度;术后1个月、3个月、6个月时就医者对重睑形态美观的满意度。结果：两组术前睑裂水平长度、睑裂垂直高度、睫毛上翘度、睫毛暴露长度比较差异无统计学意义（P>0.05）;术后6个月时较术前增加，且A组高于B组，差异有统计学意义（P<0.001）。A组术后1周时切口痕迹、睁眼闭眼自然度、上睑提肌力量评分均高于B组，差异有统计学意义（P<0.001）。两组术后即刻肿胀程度比较差异无统计学意义（P>0.05）;A组术后1周、术后1个月时肿胀程度轻于B组，差异有统计学意义（P<0.001）。术后1个月、3个月、6个月时A组对重睑形态美观的满意度均高于B组，差异有统计学意义（P<0.001）。结论：先天性单睑就医者重睑成形术中采取皮肤-上睑提肌腱膜固定法、眼轮匝肌-上睑提肌腱膜固定法均可达到固定效果，但是眼轮匝肌-上睑提肌腱膜固定重睑成形术后肿胀程度轻一些，术后形态美观度更好。

[关键词]先天性单睑;重睑成形术;眼轮匝肌-上睑提肌腱膜固定;皮肤-上睑提肌腱膜固定;形态;美观度

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）07-0047-04

Effect of Two Different Fixation Strategies of Blepharoplasty on Postoperative Appearance of Patients with Congenital Single Eyelid

CHAI Jian，ZHANG Yan，WANG Ying

（Department of Ophthalmology，Panzhihua Hospital of Integrated Chinese and Western Medicine，Panzhihua 617000，Sichuan，China）

Abstract： Objective  To discuss the influence of different fixation strategies to postoperative morphological aesthetics in blepharoplasty of congenital single eyelid. Methods  96 cases women with congenital single eyelid were selected and randomly divided into the group A and the group B， there was 48 cases in each group. Patients in the group A underwent intraoperative orbicularis oculi muscle-aponeurosis of the upper eyelid for suture fixation. Patients in the group B underwent intraoperative skin-aponeurosis of the upper eyelid for suture fixation. The horizontal length of blepharoplasty， the vertical height of blepharoplasty， the degree of eyelash upwarping and the length of eyelash exposure were observed before and 6 months after operation. One week after operation， the incision marks， the naturalness of opening and closing eyes， and the strength of levator palpebrae superioris were observed. The swelling degree of the operation area was compared immediately after operation， one week after operation and one month after operation. The patients' satisfaction with the appearance of double eyelids at one month， 3 months and 6 months after operation was compared. Results  There was no significant difference in the horizontal length of blepharoplasty， the vertical height of blepharoplasty， the degree of eyelash upwarping and the length of eyelash exposure between the two groups （P>0.05）. At 6 months after operation， those was increased in two group， and and those was higher in the group A than the group B， the differences were statistically significant （P<0.001）. Incision marks， naturalness of opening and closing eyes， strength score of levator superioris muscle at one week after operation was higher in the group A than the group B （P<0.001）. Degree of immediate postoperative swelling was no significant difference in two groups at that time after operation （P>0.05）. Degree of swelling was less in the group A than the group B at one week and one month after operation （P<0.001）. Satisfaction of double eyelid appearance at one month， 3 months and 6 months after surgery were higher in the group A than the group B （P<0.001）. Conclusion  The orbicularis oculi muscl-aponeurosis of the upper eyelid for suture fixation and skin-aponeurosis of the upper eyelid for suture fixation can achieve fixation effect in blepharoplasty of congenital single eyelid， but degree of swelling was less after heavy blepharoplasty with orbicularis oculi muscle-aponeurosis of the upper eyelid for suture fixation， and the postoperative appearance was better.

Key words： congenital single eyelid; blepharoplasty; orbicularis oculi muscle-aponeurosis of the upper eyelid for suture fixation; skin-aponeurosis of the upper eyelid for suture fixation; morphological; aesthetics

重睑是指位于睑板上缘的一条较为明显且与皮纹走向一致的横弧形浅沟，距睑缘5～6mm，现代人的审美观认为重睑具有更好的美学效果。我国单睑人群的比例约为50%，随着生活水平的提高，人们对美的追求也更高，通过手术将单睑变为重睑已经成为美容外科开展最广泛的手术之一。重睑术是根据重睑的形成原理尽可能将上睑提肌纤维或者上睑板与上睑重睑线外皮肤或者眼轮匝肌粘连……