【作者】 张文静；

【导师】 赵自然；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2024， 硕士

【摘要】 研究背景:下睑倒睫属于临床常见疾病,好发于儿童、青少年及老年人群。异常方向生长的下睑睫毛由于触及角膜常引起极为不适的眼部症状,包括眼部异物感、刺痛、畏光及流泪等症状,对患者的日常生活造成严重的影响。目前针对下睑倒睫的治疗方式有很多,主要包括非手术治疗和手术治疗两大类。其中非手术治疗主要有机械拔除、电解法、冷冻以及激光消融,此类操作简单易行,但是术后并发症较多且极易复发,并不是治疗倒睫的首选。手术治疗则包括埋线法、眼轮匝肌缩短术(Wheeler-Hisatomi法)、改良Hotz法切除多余眼轮匝肌及皮肤、改良Hotz法联合下睑缩肌切断术等方法,必要时也可与灰线劈开术及内眦成形术联合使用。由于引起下睑倒睫的原因、患者的倒睫数量及程度均有差异,针对不同的病情的患者应选取不同的手术治疗方案。随着医学水平的发展与进步,越来越多的患者在治愈疾病的同时,对于术后美观度的要求也进一步提高。因此,我们从下睑内层与外层力学平衡角度出发,采用下睑缩肌切断术来矫正下睑倒睫,并与改良Hotz法联合使用,在矫正下睑倒睫的同时有效地降低术后复发率,同时兼顾了术后美观。研究目的:观察下睑缩肌切断术联合改良Hotz法治疗复发性下睑倒睫的临床疗效,并对此手术方案的可行性与手术要点展开分析与讨论。方法:选自2021年7月至2023年5月就诊于吉林大学第一医院乐群院区下睑倒睫患者21例进行研究,年龄8岁～85岁。纳入研究的患者,其体征均为睫毛生长方向异常,伴或不伴眼睑皮肤松弛及不同程度的异物感、流泪及畏光等症状,同时所有患者在手术前均对倒睫有过干预治疗,且伴有不同程度的复发。对此21例患者采用下睑缩肌切断术联合改良Hotz法力对下睑倒睫进行矫正,观察患者术后倒睫矫正效果及复发率。结果:本组21例患者于1周拆线,下睑及周围组织轻度肿胀部分可伴淤青,伤口愈合良好,倒睫明显改善,无下眼睑退缩及内翻的情况。术后随访大于半年,下睑倒睫无复发,眼睑形态美观,患者满意。结论:下睑缩肌切断术联合改良Hotz法矫正下睑倒睫,该方法从倒睫的发病机制为出发点,根据睫毛所受的下睑内外层作用失衡这一原理,通过手术重新建立力学平衡,从而使下睑睫毛恢复其正常的生长方向。术后疗效显著,复发率低,且同时兼顾美观,患者满意度较高,值得在临床推广与应用。更多还原

【Abstract】 Background:Lower eyelid impaction is a common clinical condition that occurs in children,adolescents and the elderly.Lower eyelid eyelashes that grow in an abnormal direction often cause severe ocular symptoms,including foreign body sensation,tingling,photophobia,and tearing due to contact with the cornea,which have a serious impact on the patient’s daily life.Currently,there are many treatment options for lower eyelid impingement,including non-surgical and surgical treatments.Non-surgical treatments include mechanical extraction,electrolysis,freezing,and laser ablation,which are easy to perform,but are not the first choice for treatment of implantation because of the high number of post-operative complications and the high risk of recurrence.Surgical treatments include threading,orbicularis oculi shortening(Wheeler-Hisatomi method),modified Hotz method of removing the excess orbicularis oculi muscle and skin,and modified Hotz method combined with lower eyelid myotomy,and can be combined with grey line splitting and medial canthoplasty if necessary.Since the causes of lower eyelid impingement and the number and degree of impingement vary,different surgical treatment options should be chosen for patients with different conditions.With the advancement of medical science,more and more patients are demanding a better aesthetic outcome while curing their condition.Therefore,from the perspective of the mechanical balance between the inner and outer layers of the lower eyelid,we used lower eyelid retraction myotomy to correct lower eyelid impaction,and used it in conjunction with the modified Hotz method to reduce the recurrence rate of lower eyelid impaction while taking into account the aesthetics of the lower eyelid.Objective:To observe the clinical efficacy of lower eyelid retraction myotomy combined with modified Hotz method in the treatment of recurrent lower eyelid impingement,and to analyse and discuss the feasibility and key points of this surgical plan.Methods:Twenty-one patients with lower eyelid impingement,aged 8 to 85 years old,who attended the Lequn Hospital of the First Hospital of Jilin University from July 2021 to May 2023,were selected for the study.The patients included in the study had signs of abnormal eyelash growth direction,with or without eyelid skin laxity and varying degrees of foreign body sensation,tearing and photophobia,and all patients had had interventions for impingement prior to surgery,with varying degrees of recurrence.In21 patients,lower eyelid impaction was treated by lower eyelid retractor myotomy combined with modified Hotz force,and the degree of impaction correction and recurrence rate were observed.Results:The stitches were removed after 1 week in 21 patients in this group,with mild swelling of the lower eyelid and surrounding tissues partly accompanied by bruising,good wound healing,significant improvement of impingement,and no lower eyelid recession and inversion.Postoperative follow-up was not less than half a year,with no recurrence of lower eyelid impingement,beautiful eyelid morphology,and patient satisfaction.Conclusions:Lower eyelid contraction myotomy combined with modified Hotz method to correct lower eyelid impingement,this method starts from the pathogenesis of impingement,according to the principle of imbalance between the inner and outer layers of impingement,re-establishing the mechanical balance through surgery,so as to make the lower eyelid eyelashes restore their normal growth direction.The postoperative efficacy is remarkable,with a low recurrence rate and a high degree of patient satisfaction,which is worth promoting and applying in the clinic.更多还原