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目的 探讨Müller肌切除术、提上睑肌-Müller肌延长术、提上睑肌肌缘切开术矫正甲状腺相关眼病上睑退缩的 临床疗效。设计 回顾性病例系列研究。研究对象 60例(98眼)以上睑退缩为主要表现的静止期甲状腺相关眼病患者。方法 将患者随机分为三组,其中组Ⅰ(32眼)采用Müller肌切除术、组Ⅱ(45眼)采用提上睑肌-Müller肌延长术、组Ⅲ(21眼) 采用提上睑肌肌缘切开术矫正退缩的上睑。手术前、后及随访期测量患者的上睑退缩量。主要指标 患者的上睑退缩量及自觉 症状。结果 术后所有患者自觉症状不同程度减轻或消失。其中79眼(80．6％)手术效果佳,19眼(19．4％)因欠矫或过矫等因 素需要再次手术治疗。组Ⅰ中上睑退缩量为2-3 mm的患者可达组内最佳矫正率(90．4％),组Ⅱ中上睑退缩量>3mm的患者可 达组内最佳矫正率(95％),组Ⅲ中上睑退缩量<2mm的患者可达组内最佳矫正率(84．6％)。结论 三种手术方法均能有效矫 正甲状腺相关眼病的上睑退缩,但根据上睑退缩程度的不同,我们可针对性地选择不同术式。
Objective To investigate the clinical effect of Müller myectomy, levator muscle lengthening operation and levator muscle myogenic excision to correct the upper eyelid retraction of thyroid associated ophthalmopathy. Design retrospective case series. The study included 60 patients (98 eyes) with upper eyelid degeneration as the main manifestations of patients with quiescent thyroid-associated ophthalmopathy. Methods The patients were divided into three groups randomly. Müller myomectomy was performed in 32 eyes (group I), levator muscle lengthening operation in 45 eyes (group Ⅱ), levator ani muscle Musculoskeletal correction of the retreated upper eyelid. The patient’s upper eyelid withdrawal was measured before, during and after surgery. The main indicators of patients with upper eyelid withdrawal and conscious symptoms. Results All patients’ symptoms relieved or disappeared to varying degrees after operation. Among them, 79 eyes (80.6%) had good surgical results, and 19 eyes (19.4%) needed reoperation due to undercorrection or overcorrection. In group I, the best correction rate (90.4%) was achieved in patients with upper eyelid withdrawal of 2-3 mm, and the best correction rate (95%) in patients with upper eyelid withdrawal> 3 mm in group II %). In group Ⅲ, the best correction rate (84.6%) in patients with upper eyelid withdrawal <2 mm was the best. Conclusion All three surgical methods can effectively correct the upper eyelid retraction of thyroid-associated ophthalmopathy, but according to the different degree of upper eyelid retraction, we can choose different surgical methods.