摘要目的 探讨完全保留眼轮匝肌的切开法重睑术的手术方法及临床效果.方法 2009年6月至2017年12月中国医学科学院整形外科医院整形九科收治352例单睑患者,女337例,男15例,年龄18～65岁,平均26岁.均行切开重睑成形术,术中完全保留切口附近及睑板前眼轮匝肌,对保留的眼轮匝肌肌肉进行深、浅层释放,形成肌皮瓣,然后完全打开眶隔暴露上睑提肌腱膜,将保留的肌肉瓣游离缘向上高位固定于上睑提肌腱膜,并同时修复眶隔.结果 本组352例,手术切口均一期愈合,无感染、血肿等并发症.52例获6～60个月随访,平均27个月,随访时见患者睁眼重睑线流畅,形态饱满,未见"肉条"外观;闭眼时切口隐蔽平整,无凹陷、沟痕和台阶样畸形,45例效果非常满意;7例不满意,其中2例单侧重睑线变浅,1例经再次手术修复,2例出现双侧重睑线宽度不对称,2例单侧出现睑缘轻度外翻(未修复).结论 眼轮匝肌深、浅层肌膜释放和眶隔高位重置技术的联合应用使再造的重睑呈现自然、动态、逼真的效果,是接近人体生理解剖结构的仿生动态自然重睑术.

abstractsObjective To explore a surgical method for the reconstruction of naturally dynamic double eyelid by fully reserving orbicularis oculi muscle. Methods Incisional double eyelid blepharoplasty were performed on 352 patients. Orbicularis oculi muscle in incisional and pretarsal area were completely preserved. Muscle was elevated from plate by resecting deep muscular myolemma and muscles to form pretarsal myocutaneous flap. Thereafter, the orbital septum was completely exposed. The free end of muscle flap was fixed to a higher position of the levator aponeurosis. The orbital septum was repaired at the same time. Results From June 2009 to December 2017, 352 patients were performed double eyelid blepharoplasty using above technique. They are 337 females and 15 males. Fifty-two patients were followed up for 6-60 months, with the mean time of 27 months. All the incisions were uneventfully healed. The new double eyelid presented smooth appearance, and the so-called "sausage" phenomena were not noticed. There was no concave groove or step-like deformity when eyes closed. Forty-five patients were satisfied with the outcomes. Two patients had shallower supratarsal folds on one side, and 1 patient underwent secondary repair. Two patients complained about asymmetry. Two patients suffered from mild unilateral eyelasheversion ( without need of reparation ) . Conclusions The combined application of deep and superficial myolemma release of the orbicularis oculi muscle, and orbital septum reset, could create a double eyelid with natural and dynamic appearance.