小切口联合埋线重睑术的临床应用
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[摘要]目的：探讨埋线重睑术的手术方法。方法：患者取站立位或坐位设计重睑宽度，一般6～8mm,设计内、中、外三点。外侧点位于外眦内侧约5mm,以外侧点为中心设计长约5mm，位于重睑线上的切口线。切开皮肤，去除眼轮匝肌，打开眶隔，去除眶隔脂肪，彻底止血后，按切开重睑的方法，用6-0美容线带提上睑肌腱膜将伤口缝合，内中二点行埋线重睑。结果：本组56例，术中取出适量眶隔脂肪，组织量类似切开重睑。上睑臃肿明显减轻，外侧小切口瘢痕不明显，效果满意。结论：上睑不松弛，但臃肿者，小切口埋线重睑是一较好的选择。
[关键词]重睑术；埋线；治疗
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)03-0389-02
Clinical application of double eyelid operation with mini-incision buried suture method
MA Xian-jie,LI Yang,LI Wei-yang,WANG Lu,DONG Li-wei
(Institute of Plastic Surgery,Xijing Hospital,The Fourth Military Medical University, Xi'an 710032,Shaanxi,China)
Abstract: Objective To explore the surgical method of double eyelid operation with mini-incision buried suture. Methods The width of double eyelid was designed when the patient was erect or sitting position. Three points which are in medial, middle and lateral were marked to the posision of width of 6-8mm in common. The lateral point is located at about 5mm medial of outer canthus. The incision was about 5mm in double eyelid line taking the lateral point as a center. Incise the skin, remove the orbicularis oculi muscle, open orbital septum, and remove the fat in the orbital septum. After hemostasis completely, suture the wound with levator palpebrae superior tarsus aponeurosis by 6-0 nylon line as the method of incisional double-eyelid operation. Buried suture double-eyelid operation was performed in the other 2 points. Results The fat volume taken from the orbital septum is similar with the fat volume in the method of incisional double-eyelid operation in all 56 cases. They all get the satisfactory results. Upper eyelid overstaff is obviously reduced. The mini-incision scar in lateral is not significant. Conclusion Double eyelid operation with mini-incision buried suture method is a good choice for the patient whose upper eyelid is not relaxed but overstaff.
Key words:double eyelid operation; buried suture; treatment
埋线重睑术是门诊常见手术，术后外形自然，恢复迅速，无手术痕迹，故易于被患者所接受。但不是所有年轻，上睑不松弛者均适合。对于上睑虽不松弛，但较臃肿者，埋线重睑后，总觉上睑肿胀，重睑外形不理想[1-2]，笔者采用在上睑外侧行0.5cm小切口，将眶隔脂肪取出，术后效果较好，现报道如下。
1 资料和方法
1.1 临床资料：本组统计自2006年1月～2010年1月，共行小切口埋线重睑术56例，均为女性，年龄18～24岁。
1.2 手术方法
1.2.1 重睑线设计：患者取站立位或座位，用41/2针头设计患者及医生均可接受的重睑宽度，一般6～8mm,将正中点用画线笔标记后消毒铺巾，用41/2针头沾亚甲兰定内、中、外三点，内、外侧点均距内外眦约0.5cm处。以外侧点为中心设计长约5mm位于重睑线上的切口线。
1.2.2 手术方法：局麻起效后，按设计切口线用尖刀切开皮肤约0.5cm，去除切口下的眼轮匝肌，暴露眶隔，止血后打开眶隔，使眶隔内脂肪疝出，在脂肪内注入麻药后，用电刀边止血边切除眶隔脂肪，此时操作要缓慢，对眶隔脂肪包膜及脂肪内明显的小血管用小尖镊止血，防止术后出血，最后将脂肪切除。按切开重睑的方法，用6-0美容线带提上睑肌腱膜将伤口缝合一针后，再将内、中二点，行埋线重睑。
1.3 结果：本组56例，行小切口埋线重睑术，术中取出的眶隔脂肪组织量类似切开重睑，15例复诊，上睑臃肿明显减轻，外侧小切口瘢痕不明显，患者满意。
1.4 典型病例：某女，22岁，因单睑并上睑臃肿就诊，行小切口埋线重睑术，术后效果好(图1)。
2 讨论
埋线重睑术因操作简便，术后重睑自然，易于被医生和患者所接受，但对于上睑臃肿者则效果欠佳，而采用小切口可去除大部分眶隔脂肪，故解决了单纯埋线效果欠佳的部分病例。
2.1重睑线的设计：埋线重睑大多数医生是在患者平卧位时设计 ......
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