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  [摘要]目的:探讨小切口去脂联合连续埋线重睑的适应证。方法:设计重睑线,在重睑线上外侧1/3做3～5mm小切口,去除部分眼轮匝肌及上睑外侧眶隔脂肪内,埋线起点位于小切口内,连续埋线后打结,提起板前筋膜进行缝挂,再次打结于小切口内。结果:76例患者术后重睑线流畅,外观自然,上睑臃肿情况得到良好改善,2例变浅,所有患者均未出现因打结引起的线结反应。结论:本术式结合埋线法与切开法的优点,操作简单,稳定性及可调性高,易于被患者接受。

 [关键词]小切口;眶隔脂肪;连续埋线;重睑成形术

 [中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)07-0954-02

 To remove orbital fat through a limited-incision combined running buried suture methods of double eyelid plasty

 LIU Ling,XIE Yong-xue,DU Tai-chao,LI Zhan- qiang,YU Bo,YUAN Yuan

 (Department of Plastic and Aesthetic Surgery,Beijing Huangsi Aesthetic Plastic Surgery Hospital,Beijing 100011,China)

 Abstract:ObjectiveTo discuss the indications of double eyelid plasty combined limited- incision with running buried suture methods.MethodsTo design double eyelidcrease lines before operation, then made a 3～5mm incision on the one third of lateral eyelid. After the part of orbicularmuscle and lateral orbital fat were removed through the limited-incision, the running buried suture methods were performed ,the knots were buried in the incisions.ResultsA total of 78 cases with this method were followed up for 6 months to 2 years. 76patients were satisfied with their results, the double-eyelidlines of 2 cases were superficial.ConclusionThis method has the advantages of buried suture and partial incision technique,it is simple and effective method.

 Key words:limited-suture; orbital fat; buried suture;construction of double eyelid

 外观臃肿的上睑是切开重睑法的常见适应证之一,这种术式由于眼睑遗留切口瘢痕并不能被所有受术者接受[1]。无手术痕迹的埋线重睑术优点在于无需拆线,恢复快。缺点是易脱落,重睑线因此消失或变浅,调整力度较小,无法处理上睑脂肪。笔者对于上睑臃肿的患者采用小切口去除脂肪联合连续埋线重睑,并在固定方式上稍做改良,使埋线重睑术更加牢靠,现报道如下。

 1资料和方法

 1.1 临床资料:本组病例78例,其中女性73例、男性5例,平均年龄29岁。患者上睑皮肤弹性较好,无明显松弛。

 1.2 方法:设计重睑线,在预定重睑线上定出a (位于小切口线上)、b、c、d、e点(图1),常规消毒铺巾,1%利多卡因局部浸润麻醉,麻醉生效后,在重睑设计线外侧做一3～5mm的小切口,去除部分皮下组织及眼轮匝肌,稍压迫上睑,使眶隔脂肪膨出,眼科剪剪开眶隔,释放出脂肪,将多余的脂肪去除并止血,用6-0号尼龙线做连续缝合,由a点刺入,在小切口内穿睑板从b点出皮肤,从b点原针眼刺入,从c点穿出,同法操作至e点,从e点穿出后返回,分别经e、d、c、b点深浅交错缝合穿过真皮后到达切口内a点处,打3～4个结后,用镊子深入切口内,提起睑板前组织,带针的一端再由外眦向内眦方向回针缝挂睑板并出针,再次与尾线打结埋于切口内,小切口用7-0无损伤线缝合1针,5天后拆线(图2)。

 1.3 结果:本组76例患者术后恢复快,术后患者满意,随访6个月～2年,患者均未出现上睑紧缩或异物感,上睑外观明显改善,重睑线自然流畅,仅2例变浅予以再次埋线修复。

 2讨论

 连续埋线重睑术是重睑成形术的常见术式之一,原理在于利用连续埋线结扎方式将上睑的真皮与轮匝肌、睑板建立一定的联系来形成重睑。操作简单,恢复快,术后对于不满意的重睑可拆除恢复,缺点在于缝线易脱落,容易出现线结反应,重睑线易消失或变浅,对于上睑较厚的患者效果不佳[2]。Kim[3]曾报道上睑三点小切口间断埋线的Oh法,可同时去除真皮、眼轮匝肌及睑板前脂肪,但需反复翻转上睑,操作相对复杂,术后不易调整 ......