全麻下额肌瓣悬吊术治疗学龄前儿童先天性上睑下垂.doc

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1、全麻下额肌瓣悬吊术治疗学龄前儿童先天性上睑下垂［摘要］目的：探讨全麻下额肌瓣悬吊术治疗学龄前儿童先天性上睑下垂的有效手术技巧。方法：在全麻下，对26例患者32只眼上睑下垂应用额肌瓣悬吊术予以矫治，术中将患侧上睑缘中央点上提到角膜上缘上1mm,外侧固定点的高度略高于中央点。结果：术后7天拆线后，26例患者32眼均有程度不等的睑裂闭合不全。术后随访17个患者19只眼,随访时间为6〜16个月。I级（良好）12只眼：上睑下垂矫正满意，重睑皱裳自然美观，睑缘位置、弧度形态比较理想,两侧对称，无明显睑裂闭合不全。II级（尚好）7只眼：

2、上睑下垂较术前有明显改善。结论：学龄前儿童可以在全麻下应用额肌瓣悬吊术的方法来矫正上睑下垂，手术关键是将患侧上睑缘上提到角膜上缘上1.5mm以上，外侧固定点的高度略高于中央点。［关键词］学龄前儿童；上睑下垂；额肌瓣悬吊术；全麻［中图分类号］R622［文献标识码］A［文章编号］1008-6455（2008）08-1151-03Treatmentfortheblepharoptosisofthepre-schoolchildrenwiththesuspensionoffrontalmuscleflapingeneralanes

3、thesiaHOUDian-ju,FANGLin,GUOXin,WANGJia-qi(TheCenterofFaceandHeck,PlasticSurgeryHospitalofPekingUnionMedicalCollege,Beijing100144,China)Abstect：ObjectiveTodiscusstechniqueandskillaboutsuspensionoffrontalmuscleflapinordertocorrectcongenitalblepharoptosisinpre-schoo

4、lchildrenundergeneralanesthesis.MethodsUndergeneralanesthesia,32eyelidsof26childrenwerecuredbysuspensionoffrontalmuscleflap・Middlepointoftheupperedgeoftheeyelidwasraised1millimeterhigherthantheupperedgeofthecornea・Thelateralpointwasfixedalittlehigherthanthemiddlef

5、ixingpointwasdone・ResuItsThesutureswereremovedsevendaysaftersurgeries・Differentlagopthalmushappenedin32eyelidsof26childrenwithnoeyesightproblem・Nineteeneyesofseventeenpatientswerefollowedupfor6to16months.Fifteeneyesweregoodeyesightandappearances・Thepatientsweresat

6、isfiedwiththeresults・Thecurveofeyelidedgesinfoureyeswasnotnatura1.Butthepatientsfeltacceptable.Lagopthalmusof14eyesdisappeared・Lagopthalmusof1to2mmoccurredinfiveeyes,Noblepharoptosisrelapsewasobserved・Cone1usionCongenita1blepharoptosisinpre-schoolchildrencanbecrue

7、dbysuspensionoffrontalmuscleflapundergeneralanesthesis・Thekeypointistoraisetheupperedgeoftheeyelid1millimeterhigherthantheupperedgeofthecorneaandtofixthelateralpointalittlehigherthanthemiddlefixingpoint.Keywords：pre-schoolchildren；blepharoptosis；suspensionoffronta

8、imuscleflap；generalamesthesia先天性上睑下垂的患者，由于视线受阻，逐渐因代偿而养成视物时的仰头、皱额、耸肩等习惯，并可影响颈椎的正常发育，可以引起废用性弱视、近视、散光等，给患儿的身体和心理发育造成了严重影响。故应尽早进行手术矫治。但以往国内外的学者们认为儿童眼睑及周围组织非