两种手术方式治疗中重度先天性上睑下垂的疗效比较

Comparisons of levator shortening and frontal myofascial suspension for treating the moderate and severe congenital ptosis

摘要:

目的：评价上睑提肌缩短术(LS)和额肌筋膜悬吊术(FMFS)治疗中重度先天性上睑下垂的疗效。

方法：回顾性分析2014-01/2017-12于我院住院手术的中重度先天性上睑下垂患者145例188眼，根据手术方式分为LS组(55例71眼)和FMFS组(90例117眼)。术后随访观察两组患者的手术疗效及并发症发生情况。

结果：术后12mo，LS组和FMFS组的手术效果\〖满意率(20.0% vs 32.2%)、基本满意率(70.9% vs 60.0%)、不满意率(9.1% vs 7.8%)\〗无明显差异(U=-1.415，P=0.147)，但年龄<5岁的患者中FMFS组满意率高于LS组(32.0% vs 8.7%)，两组患者手术疗效有明显差异(U=-2.244，P=0.025)。本组患者手术并发症均发生于术后1～15d，其中结膜脱垂仅发生于LS组(11例11眼)，眼睑血肿仅发生于FMFS组(4例4眼)，暴露性角膜炎、睑内翻倒睫、睑缘畸形、睑球分离在两组患者中均有发生。

结论：LS术和FMFS术对中重度先天性上睑下垂均有良好的矫正效果，FMFS术在5岁以下患者中手术满意率更高。

Abstract:

AIM: To evaluate the effects and complications of levator shortening(LS)and frontalis myofascial suspension(FMFS)for the moderate and severe congenital ptosis.

METHODS: Totally 145 cases(188 eyes)with moderate and severe congenital ptosis were analysed retrospectively, hospitalized from January 2014 to December 2017. The clinical effect of both LS group(55 cases 71 eyes)and FMFS group(90 cases 117 eyes)were compared, and the complications of the two groups were observed.

RESULTS: The satisfaction rate, basic satisfactory rate and unsatisfactory rate of the two groups were no significant differences(U=-1.415, P=0.147)at postoperative 12mo. But in three different age groups analysis(<5, 5-10 and >10 years old group), FMFS group had the higher satisfactory rate(32.0% vs 8.7%)in <5 years old group(U=-2.244, P=0.025). Eleven eyes of 11 cases with conjunctival prolapsed only occurred in the LS group, 4 eyes of 4 cases with eyelid hematoma only occurred in the FMFS group. However, exposure keratitis, eyelid trichiasis, eyelid contour deformity and blepharoplasty separation occurred in both groups.

CONCLUSION: Both surgery methods have the good treatment effects on the moderate and severe congenital ptosis. FMFS has the higher satisfaction rate and the lower unsatisfactory rate in the infant <5 years old.