重睑成形术中缝针脱入眼睑内3例

重睑成形术中缝针脱入眼睑内3例

单凤梅李洁杨莎冯雪莹王富华

本文来源：《中华整形外科杂志》2023年3月第39卷第3期

DOI:10. 3760 / cma.j.cn114453-20220412-00105

作者单位：山东第一医科大学附属眼科医院山东省眼科医院山东第一医科大学附属眼科研究所山东省眼科学重点实验室-省部共建国家重点实验室培育基地山东第一医科大学眼科学院，济南250012

通信作者：王富华，Email：wfhdylan@163.com

引用本文

单凤梅, 李洁, 杨莎, 等. 重睑成形术中缝针脱入眼睑内3例 [J] . 中华整形外科杂志, 2023, 39(3) : 313-317. DOI: 10.3760/cma.j.cn114453-20220412-00105.

【摘要】

2017年12月至2019年2月山东省眼科医院眼整形科收治了3例(3眼)埋线法重睑成形术中缝针脱入眼睑内的女性患者，作者对病例特点和治疗措施进行了病例报道。患者年龄19~35岁，平均25岁。就诊时间为重睑成形术后1~14 d，眼睑伤口均无感染迹象，双侧睑裂高度基本对称，眼球检查未见明显异常。眼眶CT检查明确缝针脱入位置均为上睑颞侧。3例患者均沿颞侧重睑线切开皮肤，在永磁铁引导下顺利取出，取出完整缝针1例、断裂缝针2例，均为钢制三角针。术后随访1个月~4年，1例随访4年，双眼睑裂高度基本对称，患眼重睑消失，已建议行重睑修复术；1例随访1.5年，双眼重睑基本对称；1例术后1个月眼睑水肿基本消失，无不适，半年失访。埋线法重睑成形术中缝针脱入组织内易发生在颞侧眼睑，眼眶CT检查和永磁铁有助于这类异物的体表定位及手术取出。

【关键词】眼睑成形术; 并发症; 异物; 电子计算机断层扫描;

Report of three cases：the analysis of suture needles left in eyelid during double eyelid blepharoplasty

Shan Fengmei, Li Jie, Yang Sha, Feng Xueying, Wang Fuhua

Eye Institute of Shandong First Medical University，Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology ,School of Ophthalmology, Shandong First Medical University, Jinan 250012,China

Corresponding author: Wang Fuhua, Email: wfhdylan@163.com

【Summary】

Authors summarized a case report of characteristics and treatment measures for three female patients (3 eyes) with sutures dislodged into the eyelids during blepharoplasty were admitted to the Department of Oculoplastics, Shandong Eye Hospital from December 2017 to February 2019. The ages of patients ranged from 19 to 35 years, with an average of 25 years. The needles were removed 1-14 days after the previous operation. None of the eyelid wounds showed infection, the height of bilateral palpebral fissures were symmetrical in all the patients, and no significant abnormalities were seen on ophthalmic examination. Orbit CT scan showed that all the stitches were located in the upper eyelid. All patients underwent skin incisions along the original double eyelid line, and needles were successfully removed under the direction of a magnet. The needles removed were whole in one case and partial in other two cases. All needles were stainless steel needles. The patients were followed up for 1 month to 4 years. One case was followed up for 4 years, the palpebral fissure height was almost symmetrical, and the double eyelid disappeared in the affected eye. Blepharoplasty was recommended. Another case was followed up for 1.5 years, the double eyelid was symmetrical. The eyelid edema of the other case resolved 1 month after the operation, and the patient was lost to follow-up half a year after surgery. The risk of surgical needle breaking and buried into the tissues in the process of double blepharoplasty should not be neglected. These accidents tend to occur in the temporal eyelid. Orbital CT scan and permanent magnet are helpful in locating and surgically removing these foreign bodies.

【Key words】Blepharoplasty; Complication; Foreign body; Computed tomography

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of Shandong Eye Hospital（SDSYKYY201712-1）.

东方人种由于眼睑解剖的特点，只有不到50%的人拥有天然的重睑，所以美容性重睑成形术在我国拥有巨大的市场，并已经成为我国眼部整形中最常见的手术。埋线法重睑成形术术后水肿恢复快，无手术瘢痕，更接近自然重睑的形态，故易于被患者接受。术后并发症多局限于重睑形态不理想、线结暴露、重睑线变浅等[1,2]，鲜见术中缝针滑脱或遗留于眼睑内的个案报道，现将我院此类病例整理归纳，旨在介绍该并发症的发生原因及预防措施，以供借鉴。

一、病例介绍

回顾性分析2017年12月至2019年2月山东省眼科医院收治的3例(3眼)埋线法重睑成形术中缝针遗留于眼睑内的患者临床资料，分别编号为病例1、病例2和病例3。

本研究经山东省眼科医院伦理委员会批准(SDSYKYY201712-1)；所有手术患者均签署书面知情同意书，同意将其资料用于本研究。

病例1，患者女，21岁，2017年12月因"右眼重睑手术中缝针脱入眼睑内4 d"就诊我科(图1)。患者在当地美容诊所行双眼埋线法重睑成形术，术中缝针穿入右眼上睑时，不慎全部进入眼睑，牵拉缝线试图拉出缝针，但缝线脱出，缝针遗留于眼睑内，当日多次尝试取出缝针均未成功。发病以来无眼疼、眼红、异物感等不适。入院后眼科检查：双眼上睑轻度肿胀，右眼上睑可见结痂，无压痛，颞侧重睑线形成不良(图1A)，睑结膜及穹窿结膜面未见异物暴露，结膜无充血，角膜上皮光滑完整；视力右眼0.5，左眼0.6；气流眼压右眼16 mmHg(1 mmHg＝0.133 kPa)，左眼15 mmHg；眼眶CT检查示右眼上睑内，近眶外上缘处有一弧形金属样高密度影(图1B，图1C)；余眼部检查未见明显异常。初步诊断：右眼眼睑异物。

病例2，患者女，35岁，2018年2月因"左眼重睑手术中缝针遗留眼睑内1 d"就诊我科(图2)。患者于当地医院行双眼埋线法重睑成形术，术中缝针折断，前段遗留于眼睑内，手术医师切开皮肤寻找缝针未成功，患者发病以来无眼疼、异物感。入院后眼科检查：双眼上睑肿胀，重睑弧度对称，左眼中外1/3重睑线可见长约10 mm皮肤切口(图2A)，眼睑无压痛，睑结膜及穹窿结膜面未见异物，结膜无充血，角膜上皮光滑完整；视力右眼0.8，左眼0.6；气流眼压右眼20 mmHg,左眼20 mmHg；眼眶CT检查示左眼上睑内，近眶外上缘处有一弧形金属样高密度影(图2B，图2C)；余眼部检查未见明显异常。初步诊断：左眼眼睑异物。

病例3，患者女，19岁，2019年2月因"右眼重睑手术中缝针遗留于眼睑内2周"就诊我科(图3)。患者2周前在当地美容机构行双眼埋线法重睑成形术，术中右眼缝针折断遗落于眼睑内，次日于该美容机构尝试取出缝针，未成功；10 d后就诊于当地医院眼科，行眼眶CT检查发现右眼上睑有金属异物存留，诊断为右眼眼睑异物，行右眼眉下切口眼睑异物取出术，仍未找到缝针。患者发病以来无眼疼、异物感等。入院后眼科检查：双眼上睑肿胀，重睑弧度自然，右眼中外1/3重睑线内见长约5 mm皮肤瘢痕(图3A)，鼻侧眉弓下缘见长约15 mm皮肤瘢痕，上睑未扪及异物，眼球各方向运动无异常，结膜无充血，角膜上皮光滑完整；视力右眼0.6，左眼0.6；气流眼压右眼12 mmHg，左眼13 mmHg；眼眶CT检查示右眼上睑内，近眶外上缘处有一弧形金属样高密度影(图3B，图3C)；余眼部检查未见明显异常。初步诊断：右眼眼睑异物。

二、治疗方法

(一)手术方法

经术前评估后在局部麻醉下行眼睑异物取出术。患者取平卧位，局部表面麻醉后根据眼眶CT显示的异物位置，在皮肤及睑结膜面应用磁铁进行定位。2%盐酸利多卡因0.3 ml+1%盐酸罗哌卡因0.3 ml混合后于上睑中外做浸润麻醉，所有患者沿重睑痕迹做长约8 mm皮肤切口，分离眼轮匝肌，打开眶隔。用眼科手术磁铁靠近切口深部，发现明显的组织隆起现象，沿隆起处分离组织后可迅速发现异物，自眶隔脂肪内取出异物，探查眶隔内无出血，以重睑成形手术方式间断缝合皮肤切口(视频1)，术后无菌纱布覆盖患眼。

(二)术后护理

术后第1天打开纱布清洁切口，保持切口清洁干燥，术后1周拆除皮肤缝线。

(三)术后观察指标

术后早期观察切口愈合情况，有无眶内出血等，随访观察重睑形态及睑裂高度变化。

三、结果

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