目的：探讨眼睑恶性肿瘤切除联合Hughes瓣修复术后患者眼表功能的动态变化规律。

方法：前瞻性自身对照研究。纳入2021年1月至 2023年12月在山西省眼科医院接受眼睑恶性肿瘤切除联合 Hughes 睑板结膜瓣修复的患者，所有肿瘤均发生于下睑。以对侧健康眼为对照，分别于术前，术后 3、6、9、12 mo进行眼表检查，包括眼表疾病指数(OSDI)评分、泪河高度(TMH)、非接触平均泪膜破裂时间(NiaBUT)、泪膜脂质层分级、上下睑睑板腺缺失面积分级、角膜荧光染色及眼红指数。

结果：本研究共纳入患者36例，失访2例(因未能完成预定随访周期而导致数据缺失)，最终纳入数据完整的患者34例进行统计分析，其中男10例(29%)，女24例(71%)，年龄33-81(平均70.08±10.92)岁。病理分型分别为：基底细胞癌(BCC)22眼(65%)，皮脂腺癌(SGC)10眼(29%)，鳞状细胞癌(SCC)2眼(6%)。肿瘤大小为4-30(平均12.64±0.31)mm，根据AJCC分期标准，T1b 14眼(41%)，T2b 18眼(53%)，T3b 2眼(6%)。术前术眼组OSDI评分高于对侧健康眼组(28.74±13.72 vs 17.47±3.02分，P<0.05)，术眼组OSDI评分于术后6、9、12 mo进一步显著升高且以术后9 mo最重(均P<0.05)，而对侧健康眼组术后各时间点OSDI评分变化不显著。与对侧健康眼组相比，术眼组TMH在术后3 mo明显升高，随后虽略下降但仍维持在较高水平(均P<0.05)； 术眼组NiaBUT在术后3 mo起持续短于术前且显著低于对侧健康眼组(均P<0.05)； 术眼组眼红指数分析整体高于对侧健康眼(均P<0.001)； 术眼组泪膜脂质层分级、上睑及下睑睑板腺缺失分级均较术前明显加重(均P<0.001)； 角膜荧光染色分级比较，术眼组在术前高于对侧健康眼组(P<0.001)，术眼组在术后3、6、9、12 mo均高于术前(均P<0.001)。

结论：下睑恶性肿瘤切除联合 Hughes 瓣修复术后，患者以蒸发过强型干眼为主要表型，上下睑睑板腺在术后 12 mo内的缺失为不可逆，角膜上皮损伤及眼表炎症持续存在。

METHODS:A prospective self-controlled study was conducted. Patients who underwent eyelid malignant tumor resection combined with Hughes tarsoconjunctival flap reconstruction(all tumors occured in the lower eyelid)at Shanxi Eye Hospital from January 2021 to December 2023 were enrolled. The contralateral healthy eye served as control. Ocular surface examinations were performed preoperatively and at 3, 6, 9, and 12 mo postoperatively, including ocular surface disease index(OSDI), tear meniscus height(TMH), non-invasive average tear film break-up time(NiaBUT), tear film lipid layer grading, upper and lower eyelid meibomian gland dropout grading, corneal fluorescein staining, and eye redness index.

RESULTS:A total of 36 patients were enrolled. Two patients were lost to follow-up because they did not complete the scheduled follow-up period, leaving 34 patients with complete data for analysis. The cohort comprised 10 men(29%)and 24 women(71%), with a mean age of 70.08±10.92 y(range 33-81 y). Histopathological diagnoses included basal cell carcinoma(BCC)in 22 eyes(65%), sebaceous gland carcinoma(SGC)in 10 eyes(29%), and squamous cell carcinoma(SCC)in 2 eyes(6%). Tumor size ranged from 4 to 30 mm(mean 12.64±0.31 mm). According to the AJCC staging system, 14 eyes(41%), 18 eyes(53%), and 2 eyes(6%)were classified as T1b, T2b, and T3b, respectively. Preoperatively, OSDI scores were higher in surgical eyes than in contralateral healthy eyes(28.74±13.72 vs 17.47±3.02, P<0.05). OSDI scores in surgical eyes further increased at 6, 9, and 12 mo postoperatively, peaking at 9 mo(all P<0.05), whereas no significant postoperative changes were observed in contralateral healthy eyes. Compared with contralateral healthy eyes, TMH in surgical eyes increased significantly at 3 mo postoperatively and remained elevated thereafter despite a slight decline(all P<0.05). NiaBUT in surgical eyes was shorter than the preoperative value from 3 mo postoperatively onward and was lower than that in contralateral healthy eyes(all P<0.05). Eye redness index in surgical eyes were consistently higher than those in contralateral healthy eyes(all P<0.001). Tear film lipid layer grade and meibomian gland dropout grades in both the upper and lower eyelids were significantly worsened postoperatively compared with baseline(all P<0.001). Corneal fluorescein staining grades were higher in surgical eyes than in contralateral healthy eyes preoperatively(P<0.001)and were higher at 3, 6, 9, and 12 mo postoperatively than at baseline(all P<0.001).

CONCLUSION: After lower eyelid malignant tumor resection combined with Hughes flap reconstruction, evaporative dry eye is the predominant phenotype. Meibomian gland dropout in both upper and lower eyelids appears irreversible within 12 mo postoperatively, and corneal epithelial damage and ocular surface inflammation persist over time.