摘要目的:探讨睑板-上睑提肌腱膜复合瓣修复中度上睑后层缺损的临床效果。方法:回顾性分析2018年1月至2022年12月河北省眼科医院收治的上睑皮脂腺癌患者的临床资料。采用Mohs显微描记手术切除肿瘤，肿瘤切除后遗留上睑全层缺损，缺损位于鼻侧或颞侧。缺损区垂直方向无睑板残留，水平方向睑板缺损范围为>1/3~≤1/2眼睑长度；采用睑板-上睑提肌腱膜复合瓣修复上睑后层缺损，采用旋转皮瓣或推进皮瓣等修复上睑前层缺损。术后对患者进行随访和观察，末次随访时评估眼睑形态及功能、上睑提肌肌力、并发症、肿瘤复发及转移情况，并调查患者对手术效果的满意度。其中，眼睑形态及功能分为良好、中等、差3个等级，患者满意度分为非常满意、基本满意、不满意3个等级。采用SPSS 21.0软件进行统计学分析，手术前、后上睑提肌肌力以 ± s表示，采用配对 t检验进行比较， P<0.05为差异有统计学意义。 结果:共纳入8例患者(8只眼),其中男2例，女6例，年龄(62.8±8.9)岁(49~71岁)。术后随访(3.4±1.4)年(1~6年)。眼睑形态及功能良好6例，中等2例；术后上睑提肌肌力为(10.4±1.2)mm，与术前[(11.8±1.4)mm]比较差异无统计学意义( t＝2.13， P＝0.052)；8例患者均出现缺损修复区睫毛缺失，2例睑缘有轻微切迹，1例上睑轻度退缩合并轻度眼睑闭合不全，患者生活未受影响且对眼睑形态及功能满意，未予特殊处理，无其他并发症出现；2例出现腮腺转移，无复发及死亡病例；患者对手术效果非常满意5例，基本满意1例，不满意2例(为腮腺转移患者)。 结论:在上睑皮脂腺癌切除后遗留的中度上睑全层缺损(缺损范围为>1/3~≤1/2眼睑长度)修复重建中，采用睑板-上睑提肌腱膜复合瓣修复上睑后层缺损，可同时恢复上睑形态和功能，并能获得较高的患者满意度。

abstractsObjective:To investigate the efficacy of tarso-levator aponeurosis composite flap in repairing moderate posterior eyelid defects.Methods:The data of patients with sebaceous gland carcinoma on the upper eyelid who admitted to Hebei Eye Hospital from January 2018 to December 2022 were retrospectively analyzed. Mohs micrographic surgery was performed for tumor resection. Eyelid full-thickness defect located on the nasal side or temporal side were formed after tumor resection. There was no residual tarsal plate in the vertical direction after tumor was removed, and the defect of the tarsal plate in the horizontal direction ranged from >1/3 to ≤ 1/2 of the eyelid length. The posterior layer defect of the upper eyelid reconstruction was performed by sliding the tarso-levator aponeurosis composite flap. A variety of flaps including rotational, advancement flaps were used for repairing anterior layer defect of the upper eyelid. The postoperative follow-up and observation were performed for patients. The morphology and function of the eyelid, the levator function, the complications, metastasis and recurrence were evaluated at the last follow-up. By the way, the patient satisfaction of surgical efficacy was investigated. Eyelid morphology and function were classified into three grades: good, moderate and poor, and the patient satisfaction was divided into three grades: very satisfied, basically satisfied and dissatisfied. Statistical analysis was performed using SPSS 21.0 software. The measurement values of levator function before and after the operation were presented as the Mean±SD, and were performed with t-test. A P-value < 0.05 was considered statistically significant. Results:A total of 8 cases of sebaceous gland carcinoma were included, consisting of 2 males and 6 females, with an average age of 62.8±8.9 (ranging from 49 to 71) years. All patients were followed up for an average of 3.4±1.4 (ranging from 1 to 6) years. There were 6 cases with good eyelid morphology and function, 2 cases with moderate eyelid morphology and function.The levator function after the operation was (10.4±1.2) mm, which was no significantly lower than that before the operation[(11.8±1.4) mm] ( t=2.13, P=0.052). Aside from the absence of eyelashes in the reconstructed area, two cases had slight traces of eyelid margin resection after the operation. One case had mild upper eyelid retraction and mild lagophthalmos after the operation, which did not affect the quality of life and the patients were satisfied with the appearance of the eyelids, and no treatment was provided. Parotid gland metastasis occurred in 2 cases.Five patients were very satisfied with the surgical efficacy, one was basically satisfied, and two were dissatisfied (2 patients with parotid gland metastasis). Conclusion:In the reconstruction of moderate full-thickness defects (ranging from >1/3 to ≤ 1/2 of the eyelid length) after sebaceous gland carcinoma resection, tarso-levator aponeurosis composite flap is used to repair the posterior layer defect. This approach not only restores the morphology and function of the eyelid but also achieves high patient satisfaction.