徐英杰 曹振平 徐岩

[摘要]目的：比較联合筋膜鞘悬吊术（CFSS）术和改良额肌腱膜悬吊术（FMS）治疗重度上睑下垂的美容效果及安全性。方法：以2018年2月-2020年12月83例重度上睑下垂患者为研究对象，根据手术方法的不同将其分为CFSS组（43例）及FMS组（40例），比较两组有效矫正率及并发症发生率;比较两组患者术前、术后7 d及1个月的眼睑活动范围、额肌肌力、提上睑肌肌力及泪腺相关指标变化情况，并分析患者术后美容效果。结果：两组有效矫正率及术后并发症发生率对比，差异无统计学意义（P>0.05）;CFSS组术后7 d及1个月的MRD1值大于FMS组（P<0.05）;CFSS组术后1个月的额肌肌力及术后7 d、1个月的上睑肌力大于FMS组（P<0.05）;两组术前及术后7 d泪膜破裂时间（BUT）、泪液分泌试验（SIt）结果对比无明显差异，CFSS组术后1个月的BUT、FL值低于FMS组（P<0.05）;CFSS组眼睑弧度及眼睑高度对称评分高于FMS组（P<0.05）;两组双重睑评分对比，差异无统计学意义（P>0.05）。结论：CFSS术与FMS术治疗重度上睑下垂的矫正效果及安全性相当，但相比于FMS术，CFSS术能提高美观度及提上睑肌肌力。

[关键词]重度上睑下垂;联合筋膜鞘悬吊术;改良额肌腱膜悬吊术;美容效果;安全性

[中图分类号]R777.4    [文献标志码]A    [文章编号]1008-6455（2022）06-0028-04

Comparison on Cosmetic Effect and Safety of CFSS and FMS in the Treatment of Severe Ptosis

XU Yingjie，CAO Zhenping，XU Yan

（Zheng Dong Shan Mei Medical Beauty Clinic，Zhengzhou 450000，Henan，China）

Abstract： Objective To compare the cosmetic effect and safety of conjoint fascial sheath suspension （CFSS） and frintaalis muscle suspension （FMS） in the treatment of severe ptosis. Methods A total of 83 patients with severe ptosis were enrolled as the research objects between February 2018 and December 2020. According to different surgical methods， they were divided into CFSS group （43 cases） and FMS group （40 cases）. The effective correction rate and incidence of complications between the two groups were compared. The changes in eyelid range of motion， frontal muscle strength， levator palpabrae muscle strength and lacrimal related indexes before surgery， at 7 d and 1 month after surgery in both groups were observed. The postoperative cosmetic effect was analyzed. Results There was no significant difference in the effective correction rate or incidence of postoperative complications between the two groups （P>0.05）. At 7 d and 1 month after surgery， MRD1 in CFSS group was greater than that in FMS group （P<0.05）. The frontal muscle strength at 1 month after surgery， levator palpabrae muscle strength at 7 d and 1 month after surgery in CFSS group were greater than those in FMS group （P<0.05）. There was no significant difference tear film break up time （BUT） and schimer test （SIt） results between the two groups before and 7 d after surgery. The BUT and fluorescence stain （FL） value in CFSS group was lower than that in FMS group at 1 month after surgery （P<0.05）， and symmetry scores of eyelid curvature and eyelid height were higher than those in FMS group （P<0.05）. There was no significant difference in double eyelid score between the two groups （P>0.05）. Conclusion The correction effect and safety of CFSS and FMS are comparable in the treatment of severe ptosis. However， CFSS can improve aesthetics and levator palpabrae muscle strength compared with FMS.

Key words： severe ptosis; conjoint fascial sheath suspension; frintaalis muscle suspension; cosmetic effect; safety

上睑下垂是由先天发育不良或后天各种神经肌肉疾病导致的，单侧或双侧上睑低垂的眼睑疾病，轻者影响眼部外观，重者遮盖部分或全部瞳孔继而影响视觉发育[1]。临床常用手术的方法进行治疗，其中联合筋膜鞘悬吊术（Conjoint fascial sheath suspension，CFSS）、改良额肌腱膜悬吊术（Frintaalis muscle suspension，FMS）是治疗该疾病的常用术式。FMS是目前国内外应用较为广泛的治疗儿童重度先天性上睑下垂的手术方法，其主要通过改善肌肉瓣的舒缩功能，来提高提上睑肌的提睑能力[2]。……