CAJ | 학술논문

目的：探讨矫正上睑凹陷的阶梯性手术方式及疗效。方法：对32例上睑凹陷者，采用切开法重睑成形术常规切口，剪开眶隔，保留眶隔脂肪包膜的完整性，首先松解眶隔脂肪包膜与提上睑肌腱膜的纤维连接，对于无上睑下垂者，PARK法行提上睑肌腱膜与切口下肌皮瓣的固定；对于合并轻中度上睑下垂者采用上睑提肌腱膜修补术、腱膜折叠术、缩短术或联合术式；然后将眶隔脂肪重置到凹陷区，或者联合自体颗粒脂肪注射到凹陷区的眶隔脂肪包膜内；最后将自体颗粒脂肪注射到眶隔前脂肪垫（又称肌下纤维脂肪组织）和(或)眼轮匝肌后脂肪垫。常规缝合切口。结果：32例（64只眼）中24例（48只眼）获6～24个月随访，平均随访10个月，上睑凹陷消失，重睑线流畅，双侧对称，眼部外观接近美学标准，无并发症。结论：对于上睑凹陷患者，采用阶梯性手术方式：恢复上睑提肌腱膜与睑板的正常连接和张力强度；使眶隔脂肪的位置和容量达到解剖结构上的恢复；重塑眶隔前脂肪垫又称肌下纤维脂肪组织和眼轮匝肌后脂肪垫的容量，在恢复上睑的解剖结构、运动功能、美化眼外形等方面取得良好的手术效果。
목적：탐토교정상검요함적계제성수술방식급료효。방법：대32례상검요함자，채용절개법중검성형술상규절구，전개광격，보류광격지방포막적완정성，수선송해광격지방포막여제상검기건막적섬유련접，대우무상검하수자，PARK법행제상검기건막여절구하기피판적고정；대우합병경중도상검하수자채용상검제기건막수보술、건막절첩술、축단술혹연합술식；연후장광격지방중치도요함구，혹자연합자체과립지방주사도요함구적광격지방포막내；최후장자체과립지방주사도광격전지방점（우칭기하섬유지방조직）화(혹)안륜잡기후지방점。상규봉합절구。결과：32례（64지안）중24례（48지안）획6～24개월수방，평균수방10개월，상검요함소실，중검선류창，쌍측대칭，안부외관접근미학표준，무병발증。결론：대우상검요함환자，채용계제성수술방식：회복상검제기건막여검판적정상련접화장력강도；사광격지방적위치화용량체도해부결구상적회복；중소광격전지방점우칭기하섬유지방조직화안륜잡기후지방점적용량，재회복상검적해부결구、운동공능、미화안외형등방면취득량호적수술효과。
Objective To explore the methods and effect of step operation in the correction of sunken upper eyelid. Methods Blepharoplasty incision was used in 32 cases.Keeping the orbital fat sac intact after orbital septum was opened.Firstly,the conjunction was released between the orbital fat sac and levator aponeurosis,PARK blepharoplasty was used for the people without blepharoptosis;levator aponeurosis restoration,plecation,shorten or combination was used in mild to moderate blepharoptosis.Then,obital fat was repositioned to the depression region,or autologous fat was injected into the orbital fat sac.Lastly,autologous fat was injected into the preseptal fat(submuscular fibroadipose tissue,SMFAT)and(or)retro- orbicularis oculi fat(SOOF).And the incision was closed routinely. Results Of 32 cases(64 eyes),24 cases(48 eyes)were available for 6 to 24 months follow-up(average,10 months)with satisfactory aesthetic and functional outcomes. Conclusions The step operation including reconstructing the conjunction of levator aponeurosis and tarsal plate, repositioning the location and volume,restoring the volume of PSF and SOOF,plays an important role for the correction of sunken upper eyelid.