【作者】 邱巧昀；

【导师】 徐靖宏；

【作者基本信息】 浙江大学 ， 外科学， 2011， 硕士

【摘要】 背景：眼袋形成的原因很多,年轻患者多为遗传因素所致眶隔脂肪肥大、增生。随着年龄增长,下睑皮肤弹性降低,眼轮匝肌退行性改变,眶隔膜张力减弱,眶内脂肪经眶隔的薄弱区向前推移形成突出的眼袋。此外,眶下部浅层软组织受重力影响而向颊部下垂而使该部位软组织变薄,形成眶下缘凹陷沟槽。传统眼袋整形术一般采用经结膜入路及经皮肤切口入路两种术式,以去除眶隔脂肪改善外凸畸形为主。多数年轻患者属于下睑脂肪突出型眼袋、皮肤弹性良好、眶睑沟浅而窄,采用结膜入路术式去除疝出脂肪；中老年人除眼袋明显外,常伴有皮肤松弛、眶睑沟深而宽,从侧面观察呈现双凸型,仅切除眶隔脂肪将使下睑不平整,局部凹陷明显,眶睑沟更加显露,故目前多采用Hamra设计的经皮肤切口入路术式,保留并释放眶隔脂肪、提紧眼轮匝肌、切除松弛皮肤。目的：针对眶睑沟严重而下睑皮肤松弛不明显的眼袋类型,设计适用性较强的手术方法。方法：术前应先评估患者情况,了解患者对手术效果的期望,进而选择合适的经结膜入路术式,释放并保留眶隔脂肪的手术方法。结果：12例眶睑沟严重而下睑皮肤松弛不明显的眼袋患者以经结膜入路释放并保留眶隔脂肪术式,改善眼袋。术后经3-6个月以上随访,表明眼袋及眶、睑沟改善明显,无并发症出现。结论：针对眶睑沟严重而下睑皮肤松弛不明显的眼袋类型,采用经结膜入路术式,释放并保留眶隔脂肪的手术方法可以达到良好的效果。更多还原

【Abstract】 Background:Lower eyelid occur in young patients for many reasons, mostly due to genetic factors, orbital fat hypertrophy, hyperplasia. As patients age, the elasticity of the lower eyelid is reduced, regression of the orbicularis oculi muscle causes the tension of the orbital membrane to weaken, leading to the formation of dermatochalasis of orbital fat moving forward to the thinner area of the orbital septum. Further, gravity affect the infraorbital superficial soft tissues to prolapse towards the cheek, causing a thinning of the soft tissue and forming the infraorbital depression groove. Conventional surgery for dermatochalasis usually uses either transconjunctival or skin incision, to improve the protrusion by removing orbital fat. Most young patients have fat protrusion of the lower eyelids, good skin elasticity, and shallow and narrow orbitopalpebral sulcus; the transconjunctival route is taken to remove the herniated fat. Other than a prominent depression, older patients present loose skin, with deep and broad orbitopalpebral sulcus; the deformity appeares to have a double convex from the side. Removal of orbital fat may cause an unevenness of the lower eyelids with more prominent partial depression and orbitopalpebral sulcus. Therefore, the skin incision route designed by Hamra was generally used to preserve and release orbital fat, lift the orbicularis oculi muscle, and remove loosened skin.Purpose:Using the appropriate surgical method to augment cosmetic defects focused on the orbitopalpebral sulcus, for patients without significant loosening of the skin and non-apparent wrinkles in the lower eyelids. Method:Before operation, we should assess the patient’s condition, understand what they expect the results of operation, and then select the appropriate surgical method: blepharoplasty of orbital fat release and preservation through transconjunctival route.Result:12 subjects received treatment using the blepharoplasty of orbital fat release and preservation through transconjunctival route; both the surgery and recovery process went smooth. The depression of the orbitopalpebral sulcus was corrected or greatly improved during the 3-6 months follow-up; dermatochalasis was improved.Conclusion:This approach should be used for patients with cosmetic defect focused on the orbitopalpebral sulcus with non-significant loosening and wrinkling of the skin in the lower eyelid for reconstruction.更多还原