四步法眼袋整形术在老年眼整形中的应用(1)
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[摘要]目的：探讨一种适合老年人病理特点的眼袋整形方法。方法：对42例(84眼)老年患者进行眼整形，其中男性4例，女性38例，平均年龄62岁。针对老年人眼袋的病理解剖特点，采用包括疝出眶隔脂肪切除或重置、眶隔加固、外眦韧带悬吊和多余皮肤切除四个步骤在内的眼袋整形技术，所有患者均于术后7天拆除切口缝线。结果：术后42例患者的眼袋和下睑松弛均得到了满意的修复，随访3～30个月，眶下区均得到年轻化改善，下睑及睑缘形态自然，无眼睑外翻发生，切口瘢痕隐蔽，不易发现，患者对外观满意。结论：四步法眼袋整形技术，对老年性眼袋的病理特点有比较强的针对性，是一种比较适合老年人的眼袋整形方法。
[关键词]老年人；下睑袋；睑成形术；眶隔加固；外眦韧带悬吊
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)05-0737-03
Four steps method blepharoplasty for the old's lower eyelid pouches
SONG Huifeng,WANG Yirong,CHEN Baoguo,GAO Quan-wen,ZHANG Pei-pei,HAO Yong-hong,CHAI Jia-ke
(Department of Burns & Plastic Surgery,The First Affiliated Hospital of PLA General Hospital,Beijing 100048,China)
Abstract: Objective To explore the method that is suitable for the old's lower eyelid pouch plasty. Methods In accordance with the characteristics of the old's low eyelid pouch, Blepharoplastic operations, including orbital septal fat resection or reposition, orbital septal strengthening, lateral tarsal ligament suspension and redundant skin resection, were performed for 42 cases (84 eyes), with 4males and 38 females, average 62 years old. Stitches were released on postoperative day 7 in all patients. Results Satisfactory results that lower eyelid deformity and skin slack were improved were obtained in all 42 patients. After 3 months to 2.5 years follow-up, lower orbit area was amended youthfully, and the shape of lower eyelid and its margin were natural. The patients were satisfied with ectropion-free and unconspicuous scar. Conlusions The method that includes four steps is fit for old blepharoplastic on the basis of the old eyelid pouch deformity.
Key words:old man eyelid pouch; blepharoplasty; orbital septal strengthening; lateral tarsal ligament suspension
老年人眼袋的病理特点与年轻人有所不同，除眶隔脂肪疝出外，其下睑皮肤、眼轮匝肌、眶隔筋膜等组织呈现退行性变，因此整复策略也应有所区别。2008年以来，笔者应用包括疝出眶隔脂肪切除或重置、眶隔加固、外眦韧带悬吊和多余皮肤切除四个步骤在内的眼袋整形技术治疗42例老年患者，收到满意效果。
1 临床资料
本组病例42例(84眼)，男性4例，女性38例，年龄最小者52岁，最大者79岁，平均年龄62岁。
2 手术方法(示意图1)
2.1 手术切口设计及切开分离：患者平卧，于下睑缘下1～2mm设计平行于下睑缘的手术切口，内侧达内眦角附近，外侧向外眦角外侧延伸3～8mm。术区采用2%利多卡因浸润麻醉，慎用肾上腺素，依次切开皮肤、眼轮匝肌，于眶隔筋膜表面充分分离，暴露眶隔筋膜及其下方的眶隔脂肪。
2.2 眶隔脂肪及眶隔筋膜的处理：打开眶隔，暴露眶隔脂肪，将眶隔脂肪充分释放，向泪沟处平铺，多余脂肪可以去除，收紧眶隔并5-0丝线缝合加固。
2.3 外眦韧带悬吊加固：在外眦角处寻找外眦韧带，将其用1-0丝线悬吊固定于眶外侧壁骨膜上，收紧松弛的眼轮匝肌。
2.4 松弛皮肤去除：嘱患者用力张嘴，同时眼睛向上看，向上牵拉下睑皮肤，确保切口无张力状态下去除多余皮肤。彻底止血后，切口7-0尼龙线间断缝合。
2.5 术后处理：切口外用红霉素眼膏，适当冰敷，加压包扎24h，术后5天拆线，勿需用抗生素，必要时可口服草木犀流浸液片 ......
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