重睑成形术中矛头状皮肤切除术矫正内眦赘皮
 |
| 第1页 |
参见附件。
[摘要]目的：探索重睑成形术中内眦赘皮矫正术的新方法。方法：在内眦部位设计矛头状皮肤切口上方与重睑线连接，下方沿下睑延长，水平切断内眦处的眼轮匝肌纤维，横向缩短内眦韧带，将赘皮缘推进缝合至鼻侧切口，消除引起赘皮的解剖学因素。结果：临床应用30例对25例进行了为期1～12个月的随访，结果所有患者的重睑形态满意，内眦矫正充分、瘢痕隐蔽。结论：此方法能充分矫正内眦赘皮，适合于重睑成形术同期施行，是一种操作简单效果满意的方法。
[关键词]重睑成形术；矛头状皮肤切除术；内眦赘皮
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)04-0568-02
Correction of epicanthus by the spearhead excision in double-eyelid blepharoplasty
CUI Zi-wei,YANG Ying,WANG Wei-dong,LI Hong-yan,HE Cheng-jun
(Department of Plastic&Cosmetic Surgery,Daqing Oilfield General Hospital,Daqing 163001,Helongjiang,China)
Abstract: Objective To explore a new method to perform the medial canthoplasty combined with the double-eyelid blepharoplasty in a single procedure. Methods A spearhead incision was designed at the medial canthus,the upper side of the incision was connected with the line of the double-eyelid, the inferior side of the incision was extended along the lower palpebral edge,the obcular muscle of medial canthus was horizontally dissected,then the medial canthal ligament was shorted flatly,the edge of epicanthus was advanced to the inner sidepiece,the abnormal factors in anatomy were eliminated. Results 25 cases of 30 patients had been followed up from 1 month to12 months. All patients achieved satisfactory aesthetic results.The epicanthus was corrected completely without the evident scars. Conclusions This is a simple and satisfactory method for epicanthus with double-eyelid blepharoplasty.
Key words:double-eyelid blepharoplasty;spear shape excision;epicanthus
东方人常有先天性内眦赘皮，如不处理将影响重睑术的美容效果[1]。很多学者提出了行重睑术同时矫正内眦赘皮的方法，主要有，“Z”成形术和改良的“Z”成形术[2-3]；“V-Y”成形术[2,4]；“L”形和Mustarde内眦赘皮矫正术等[2]，均取得了一定的治疗效果。笔者受矛头状皮肤切除术矫正外眦钝圆[5]的启发，在重睑成形术中行矛头状皮肤切除术矫正内眦赘皮，自2007年10月至2008年10月临床应用30例，取得了良好效果。
1 资料和方法
1.1 临床资料：本组共30例，男5例，女25例，年龄18～42岁，平均25岁。
1.2 手术方法
1.2.1 手术设计：在内眦部位定出正常内眦点A，标记赘皮缘全长BC，连接AB和AC，将AC沿下睑缘向外侧延长，通常延长1～1.5cm，ABC围成的矛头状皮肤在术中切除，距睑缘6～8mm画重睑成形术切口线，内侧端与B点相连。根据情况画出上睑应当切除的皮肤量(图1)。
1.2.2 手术步骤： 1%利多卡因加1∶200 000肾上腺素行局部浸润麻醉。沿所画设计线切开皮肤、皮下组织，切除ABC矛头状皮肤，经下睑缘切口在皮肤和眼轮匝肌之间向下方做少许剥离，然后将ABC区域深层的眼轮匝肌纤维横向剪断，暴露出肌肉下方的内眦韧带全长，然后沿重睑线切口，向下分离掀起睑板前皮瓣，去除睑板前的眼轮匝肌，若眶脂脱垂，适当去除，清楚暴露睑板上缘和内外眦端，用5-0慕丝线将内眦韧带横向折叠缩短缝合1针，此时可见内眦开大，赘皮纠正，泪阜完全显露，用8-0尼龙线缝合ABC区域及下睑缘处的切口，如下睑多余皱襞处出现“猫耳”，可适当延长下睑缘切口线。用6-0尼龙线按常规重睑成形术缝合重睑线切口。
1.2.3 术后处理：术毕切口处涂红霉素眼膏，局部用纱布覆盖，术后第2天，清洁伤口后涂红霉素眼膏，敞开伤口。术后第7天拆线。
1.3 结果：对25例患者进行了1～12个月的随访，结果显示25例内眦角开大，赘皮消失，泪阜完全显露，内眦处均无明显瘢痕增生,重睑效果良好(图2、3)。
2 讨论
2.1 内眦赘皮是因为内眦部眼轮匝肌结构异常而在内眦角部位形成的皮肤皱襞，宋建星等[6]认为内眦赘皮的成因是由于眼轮匝肌起始部错位所致，杨宇等[7]认为其成因是由于眼轮匝肌浅头的位置异常和内眦韧带浅头的延长引起 ......
您现在查看是摘要介绍页，详见PDF附件(1022kb)。