目的：A型肉毒杆菌毒素(Botox)联合眼睑手术治疗面肌痉挛(HFS)疗效观察。

方法：回顾性分析患者的影像和医疗记录，并对注射Botox的患者治疗效果和并发症进行分析。

结果：共纳入76例(女性58例)HFS患者至少接受4次Botox注射。平均随访时间为83±50(20～112)mo，平均注射16±10(4～34)次。发病高峰年龄为55～64a，平均发病年龄为66±11(32～85)a。多达23%的面肌痉挛患者存在与面神经关系密切的异常血管结构(右侧8例，左侧7例)(MRI=14， CT=1)，其中以椎动脉累及最多(n=6)，其次是小脑前下动脉(n=5)。原发性HFS患者的有效期间较继发性HFS患者短(2.5 vs 3.1mo， P<0.05)，发病时间较继发性HFS患者长(4.1 vs 3.8d， P=0.739)，SSAs较继发性HFS患者低(1.7 vs 1.9， P=0.179)。19例先前存在眼睑疾病的患者中有12例接受了手术矫正，包括上睑成形术(n=12)、肌肉切除(7例)、眉成形术(7例)和提上睑肌腱膜修复术(5例)。5例(41.7%)接受手术矫正和对肉毒杆菌素反应不佳的患者术后6mo症状改善(发病时间：P=0.0256，有效期间：P=0.374，SSAs：P=0.0161)。12例行眼睑手术患者术后并发症发生率低于未行眼睑手术患者(23% vs 42%， P≤0.05)。

结论：Botox对于治疗HFS是一种安全有效的方法。继发性HFS患者使用肉毒杆菌毒素的治疗效果优于原发性HFS患者。对于并发眼睑疾病的患者而言，眼睑手术可提高患者满意度，降低并发症发生率，从而提高后续Botox注射的效果。

METHODS: Patients' images and medical notes were retrospectively reviewed with subsequent analysis of both the therapeutic outcomes and complications of Botox injections.

RESULTS: The information of 76 patients(Female=58)with HFS who received a minimum of 4 Botox injections were included. The mean follow-up interval was 83±50(20-112)mo with an average of 16±10(4-34)injections. The peak incidence was between 55 and 64 years and the average age of onset was 66±11(32-85)years. Up to 23% of patients with HFS had aberrant vascular structures(Right=8, Left=7)in close relationship to the facial nerve(MRI=14, CT=1), where the vertebral artery(n=6)was the most involved vessel followed by the anterior inferior cerebellum artery(n=5). Patients with primary HFS had a shorter effective duration(2.5 vs 3.1mo, P<0.05), a longer onset time(4.1 vs 3.8d, P=0.739)and a lower Subjective Spasm Alleviation score(SSAs)(1.7 vs 1.9, P=0.179)than those with secondary HFS. Twelve of the 19 patients with pre-existing eyelid diseases underwent surgical correction including upper blepharoplasty(n=12), limited myectomy(n=7), browplasty(n=7)and advancement of levator aponeurosis(n=5). Five(41.7%)of those with surgical correction and suboptimal response to Botox showed improvement 6mo after surgery \〖onset time(P=0.0256), effective duration(P=0.374)and SSAs(P=0.0161)\〗. Those 12 patients with eyelid surgery had a lower complication rate than those without eyelid surgery(23% vs 42%, P≤0.05).

CONCLUSION: Botox is an effective and safe treatment for HFS. We found that patients with primary HFS had a less favorable therapeutic outcome with Botox than those with secondary HFS. Eyelid surgery for patients with concurrent eyelid diseases can augment the effect of subsequent Botox injections by improving patient satisfaction and reducing complication rate.