摘要
目的对比皮肤-眼轮匝肌瓣切除术和皮肌瓣联合外侧睑板楔形切除术矫正老年性睑板腺功能障碍患者下睑内翻的临床效果。方法选取2016年8月至2018年1月在南昌大学第一附属医院眼科确诊为下睑内翻的老年性睑板腺功能障碍患者40例(80眼)作为研究对象,根据手术方式不同分为两组,A组行皮肤-眼轮匝肌瓣切除术,B组行皮肌瓣联合外侧睑板楔形切除术。两组分别于术前和术后1周、1个月行睑缘评分、睑板腺挤压试验、睑板腺分泌功能试验、脂质分泌情况评分、泪液分泌试验、泪膜破裂时间、角膜荧光素染色、眼表症状及体征评分等,并作对比。结果术后1个月与术前相比,除B组干涩症状外,其余A、B两组眼部症状均有明显好转,差异均有统计学意义(均为P<0.05);与B组相比,A组术后1个月时干涩、疼痛、异物感、灼烧感和流泪症状缓解情况更为明显,差异均有统计学意义(均为P <0.05)。术后1个月,B组睑脂评分较术前升高,且较A组升高,差异均有统计学意义(均为P <0.05);其余睑板腺相关指标术后1周、1个月与术前相比差异均无统计学意义(均为P>0.05)。术后1个月,两组眼部OSDI评分、泪液分泌试验、角膜荧光素染色、泪膜破裂时间均较术前明显改善,差异均有统计学意义(均为P <0.05);与B组相比,A组角膜荧光素染色评分更低、泪膜破裂时间延长更显著,差异均有统计学意义(均为P <0.05)。结论对于老年性睑板腺功能障碍伴下睑内翻患者,皮肤-眼轮匝肌瓣切除术优于皮肌瓣联合外侧睑板楔形切除术。
Objective To compare the ocular surface changes caused by simple skin-orbicularis oculi muscle flap resection and skin flap combined with lateral blepharoplasty for entropion of lower lid in meibomian gland dysfunction(MGD)patients.Methods Forty MGD patients(80 eyes)diagnosed with lower eyelid inversion in the First Affiliated Hospital of Nanchang University from August 2016 to January 2018 were selected as objects of this study.According to the differences of the surgical methods,the patients were divided into two groups.The A group was treated with simple skin-orbicularis oculi muscle flap resection.The B group was treated with skin flap combined with lateral blepharoplasty.Several testes including palpebral margin score,testing meibomian gland after extrusion,meibomian gland secretion function test,lipid secretion score,schirmeri test(SIT),break-uptime(BUT),corneal fluorescein staining(CSF),ocular surface symptoms and physical scores were performed in two groups and compared respectively before and one week and one month after operation.Results One month after surgery,except for the dry and astringent symptoms of group B,the eye symptoms of both group A and group B improved significantly,and the difference was statistically significant(all P<0.05).Compared with group B,the symptoms of dryness,pain,foreign body sensation,burning and tears in group A were significantly relieved one month after surgery,with statistically significant differences(all P<0.05).Compared with group A,the meibum score of group B was increased one month after surgery,and the difference was statistically significant(P<0.05).There were no significant differences in the other indexes of meibomian gland between before surgery and 1 week,1 month after operation(all P>0.05).One month after surgery,OSDI,SIT,CSF and BUT were significantly improved in both groups when compared with before surgery,and the difference was statistically significant(all P<0.05).Compared with group B,the CSF score of group A was lower,but BUT was longer,and the difference was statistically significant(all P<0.05).Conclusion For elderly MGD patients with lower eyelid entropion,simple skin-orbicularis oculi muscle flap resection is better than skin flap combined with lateral blepharoplasty.
作者
石文卿
孙铁
朱佩文
徐晓玮
刘康成
林启
闵幼兰
徐蔓薇
叶蕾
袁晴
邵毅
SHI Wen-Qing;SUN Tie;ZHU Pei-Wen;XU Xiao-Wei;LIU Kang-Cheng;LIN Qi;MIN You-Lan;XU Man-Wei;YE Lei;YUAN Qing;SHAO Yi(Department of Ophthalmology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi Province,China)
出处
《眼科新进展》
CAS
北大核心
2018年第11期1041-1044,共4页
Recent Advances in Ophthalmology
基金
国家自然科学基金资助(编号:81460092、81400372、81660158)
江西省远航工程(编号:2014022)
江西省自然科学基金重大项目(编号:2016ACB21017)
江西省自然科学基金(编号:20151BAB215016)
江西省重点研发项目(编号:20151BBG70223)
关键词
睑板腺功能障碍
下睑内翻
皮肤-眼轮匝肌瓣切除术
皮肌瓣联合外侧睑板楔形切除术
meibomian gland dysfunction
lower eyelid entropion
skin-orbicularis oculi muscle flap resection
skin flap combined with lateral blepharoplasty
