摘要目的 评价鼻中隔软骨黏膜瓣联合眶周表浅肌肉腱膜系统(SMAS)皮瓣移植修复大面积眼睑全层缺损的疗效.方法 对2011年1月至2014年5月在滨州市中心医院眼科就诊的7例(7只眼)眼睑恶性肿瘤的患者,手术切除肿瘤后眼睑全层缺损均超过了眼睑长度的4/5,一期采用鼻中隔软骨黏膜瓣联合眶周表浅肌肉腱膜皮瓣移植重建眼睑全层,带单侧鼻黏膜的鼻中隔软骨作为眼睑内层(睑结膜和睑板)的替代材料,眶周表浅肌肉腱膜系统皮瓣作为眼睑外层(肌肉及皮肤).手术首先彻底切除眼睑肿瘤组织,术中送快速病理,明确肿瘤性质及切缘是否有癌细胞浸润.制备带单侧鼻黏膜的鼻中隔软骨瓣,然后根据眼睑外层缺损位置及大小设计SMAS转位皮瓣,术毕睑裂缝合1个月拆线.结果 所有患者随访8～24月,平均17.8个月,移植瓣全部成活,眼睑外观及功能较满意,且无干眼症状发生.结论 鼻中隔软骨黏膜瓣联合眶周表浅肌肉腱膜皮瓣移植,可重建因眼睑巨大恶性肿瘤切除所致的大面积缺损的眼睑全层,疗效肯定,具有较高的临床价值.

abstractsObjective To evaluate the effect of the nasal septum chondro mucosal flap with the orbicularis superficial musculo-aponeurotic system (SMAS) flaps in reconstruction of a large eyelid defects.Methods Seven cases of malignant tumor of eyelid were with large full-thickness eyelid defects more than 4/5 length of eyelid after the tumor being radically excised at the central hospital of Binzhou from January 2011 to May 2014.The nasal septum chondro mucosal flap was used to replace the inner lamella (tarsus and conjunctiva),and the orbicularis superficial musculo-aponeurotic system (SMAS) flaps were to reconstruct the outer layer (skin and orbicularis oculis muscle).Intraoperative rapid pathological nature of the tumors was sent to clarify the tumor nature and the margin if there was invasion of cancer cells.The nasal septal cartilage with unilateral nasal mucosa was prepared.Orbicularis SMAS flap were then designed according to the location and scope of the defect of the outer layer of the eyelids and transposition procedure ensued.After the operation,the tarsorrhaphy was performed in all cases and the closure was maintained for one month.Results All patients were follows for 8 to 24 months,averaged 17.8 months.The nasal septum chondro mucosal flap with orbicularis SMAS flap existed well in all cases.The satisfactory aesthetic and functional results were achieved.No dry eye symptoms were observed in all cases.Conclusions The nasal septum chondro mucosal flap with the orbicularis superficial musculo-aponeurotic system (SMAS) flaps can reconstruct the full-thickness eyelid defects large area after eyelid huge malignant tumor excision as a one-stage operation with good outcome and high clinical value.