全身麻醉下行儿童先天性上睑下垂提上睑肌缩短术的量化研究

A quantitative approach to shortening the levator palpebrae superioris to correct congenital ptosis in children

摘要:

目的：探寻一种全身麻醉下行提上睑肌缩短术时术前量化的方法。

方法：收集64例102眼儿童上睑下垂患者， 根据上睑下垂的程度将其分为三组：轻度(<2 mm)，中度(3～4 mm)及重度(>4 mm)。所有病例均采用提上睑肌缩短术，术前采集标准照片， 并通过Image J软件测量患眼上睑缘至角膜下缘的高度，利用公式计算出术中上睑缘需达到的高度，并根据计算结果实施手术。术后评价标准包括上睑缘高度，巩膜暴露度以及暴露性角膜炎的发生情况。所有患者均于术后1wk，1mo、6mo时进行随访。

结果：在术后早期阶段，轻、中度组各1眼出现过矫情况，轻度组和中度组所有患者的上睑缘位置均位于正常高度。术后6mo时，中度组的过矫眼有所提高，轻度组的过矫眼仍处于过矫状态，重度组中有7例出现了不同程度的欠矫。术后眼睑闭合良好，未出现暴露性角膜炎。

结论：这种术前通过公式计算全身麻醉下上睑下垂患者术中需要达到的上睑缘高度的方法，不仅为全身麻醉下行提上睑肌缩短术提供更为准确的依据，同时也提高了全身麻醉下行提上睑肌缩短术的成功率。

Abstract:

AIM:To develop a feasible method to correct congenital ptosis in children.

METHODS: Sixty-four patients(102 eyelids)were divided into three groups based on the degree of ptosis: mild(<2 mm); moderate(3-4 mm)and severe(>4 mm). All patients underwent the same levator resection surgery in which the suspensory system of the LPS is retained. After capturing a standard photograph of primary position, the height of the superior palpebral margin was measured preoperatively by using Image J software to calculate its ideal height required during surgery. Postoperative outcome measures included upper eyelid margin height, degree of scleral exposure and exposure keratitis. The patients were followed-up at 1wk, 1mo and 6mo postoperatively.

RESULTS: In the early postoperative period, except two cases with overcorrection, the positions of the eyelid upper margins were normal in all cases in the mild and moderate groups. Six months postoperatively, the eye with overcorrection in the moderate group showed improvement, while the eye in the mild group did not. Seven eyes in the severe group exhibited residual ptosis to varying degrees. The eyelids exhibited appropriate closing functionality; exposure keratitis was absent.

CONCLUSION:Using this preoperative quantification technique to guide surgery not only provided a gauge for LPS shortening under general anesthesia, but also increased the success rate of surgery.