【摘要】 目的探讨甲状腺相关性眼病(TAO)上睑退缩的治疗方法。方法回顾分析临床资料完整的55例72眼TAO上睑退缩患者的治疗效果。分别采用上睑局部注射A型肉毒杆菌毒素、Müller肌切除术联合提上睑肌部分切断术、提上睑肌-Müller肌延长术治疗TAO上睑退缩。活动期或病情稳定时间<6个月的静止期患者采用上睑注射A型肉毒杆菌毒素治疗;病情稳定时间>6个月的静止期患者中,轻度和中度上睑退缩者采用Müller肌切除术联合提上睑肌部分切断术治疗,中度和重度上睑退缩者采用提上睑肌-Müller肌延长术治疗。术毕以轻度过矫为宜。结果上睑局部注射A型肉毒杆菌毒素治疗12例15眼,治疗后上睑退缩完全消失4例5眼,明显改善7例8眼,无效1例2眼,治疗有效率为86.7%(13/15)。Müller肌切除术联合提上睑肌部分切断术治疗32例43眼,治疗后上睑退缩完全消失16例23眼,明显改善11例15眼,无效5例5眼,治疗有效率为88.4%(38/43)。提上睑肌-Müller肌延长术治疗11例14眼,治疗后上睑退缩完全消失7例9眼,明显改善2例3眼,无效2例2眼,治疗有效率为85.7%(12/14)。3种治疗方法间治疗有效率的差异均无统计学意义(P值均>0.05)。上睑注射A型肉毒杆菌毒素治疗后欠矫1例2眼;Müller肌切除术联合提上睑肌部分切断术治疗后欠矫3例3眼,轻度过矫2例2眼;提上睑肌-Müller肌延长术后欠矫1例1眼,轻度过矫1例1眼。结论 TAO上睑退缩宜采用综合治疗措施。A型肉毒杆菌毒素治疗适用于活动期患者、眼局部应用人工泪液和眼膏难以缓解症状者;病情稳定时间>6个月的静止期患者,可手术治疗。更多还原

【Abstract】 Objective To investigate therapeutic methods of upper eyelid retraction in patients with thyroid associated ophthalmopathy(TAO).Methods The therapeutic effect on upper eyelid retraction in 55 TAO patients(72 eyes)was analyzed retrospectively in this study.The patients were treated with local injection of type A botulinum toxin on upper eyelid or surgical treatment according to their different situations.Patients in the active stage or in the quiescent stage less than 6 months were treated with botulinum toxin injection.Surgery was used in the patients in the quiescent stage for more than 6 months.Müller muscle resection in combination with partial amputation of levator muscle was used for mild to moderate upper eyelid retraction.Lengthening of the levator aponeurosis and Müller muscle was used for moderate to severe upper eyelid retraction.It was advisable to over correct slightly after surgery.Results In the 12 patients(15 eyes)with botulinum toxin injection,the clinical outcome was ideal in 4 patients(5 eyes)and acceptable in 7 patients(8 eyes);the effective treatment was86.7%(13/15).In 32 patients(43 eyes)who underwent Müller muscle resection combined with partial amputation of levator muscle,the clinical outcome was ideal in 16 patients(23 eyes)and acceptable in 11 patients(15 eyes);the effective treatment was 88.4%(38/43).In 11 patients(14 eyes)undergoing the lengthening of the levator aponeurosis and Müller muscle,the clinical outcome was ideal in 7 patients(9 eyes)and acceptable in2 patients(3 eyes);the effective treatment was 85.7%(12/14).No significant difference was found in the efficiencies three treatments(P>0.05).One patient(2 eyes)was undercorrected with botulinum toxin injection.Three patients(3 eyes)were undercorrected and two patients(2 eyes)were slightly overcorrected after Müller muscle resection combined with partial amputation of levator muscle.One patient(1 eye)was undercorrected and another patient(1 eye)was slightly overcorrected after the lengthening of the levator aponeurosis and Müller muscle.Conclusion Comprehensive treatment should be adopted for upper eyelid retraction in TAO patients.Botulinum toxin injection is suitable for the patients in the active stage or those in whom symptoms cannot be relieved after applying artificial tears or oculentum,while surgery may be required to correct eyelid retraction in quiescent patients.(Shanghai Med J,2017,40:439-443)更多还原