额肌瓣悬吊术与上睑提肌缩短术治疗上睑下垂有效性及安全性的Meta分析

刘剑 孙家明

[摘要]目的：比较额肌瓣悬吊术与上睑提肌缩短术治疗不同程度上睑下垂的有效性及安全性。方法：通过中国知网、万方数据库、维普、中国生物医学文献服务系统、PubMed、EMBASE和Cochrane图书馆，系统检索与额肌瓣悬吊术及上睑提肌缩短术治疗上睑下垂相关的文章。利用STATA 12.0软件，使用随机效应模型，计算纳入的各项研究比值比（Odds ratio，OR）及95%可信区间（Confidence intervals，CI），并进行合并分析。结果：本次纳入19篇文献，共1 588例患者。结果显示：利用额肌瓣悬吊术治疗不同程度上睑下垂的有效性与上睑提肌缩短术相比差异无统计学意义（OR=0.97，95%CI：0.50～1.86），但是并发症发生率较高（OR=2.34，95%CI：1.19～4.61），安全性较差。两种术式应用于中、重度上睑下垂治疗，额肌瓣悬吊术的有效性与上睑提肌缩短术相比差异无统计学意义（OR=0.73，95%CI：0.35～1.53），但是并发症发生率进一步升高（OR=3.17，95%CI：1.51～6.64）。结论：额肌瓣悬吊术治疗不同程度上睑下垂的临床疗效与上睑提肌缩短术相当，但是后者的并发症发生率更低，安全性较高。

[关键词]额肌瓣悬吊术;上睑提肌缩短术;上睑下垂;Meta分析;有效性;安全性;并發症

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）03-0001-05

Efficacy and Safety of Frontalis Muscle Flap Suspension and Shortening of Musculus Levator Palpebrae Superioris in the Treatment of Blepharoptosis： A Meta Analysis

LIU Jian，SUN Jia-ming

（Department of Plastic Surgery，Union Hospital，Tongji Medical College，Huazhong University of Science and Technology，Wuhan 430022，Hubei，China）

Abstract： Objective  To compare the efficacy and safety of frontalis muscle flap suspension and shortening of musculus levator palpebrae superioris in the treatment of different degrees of blepharoptosis. Methods  We systematically performed a search for published studies on CNKI， Wanfang Database， VIP Database， SinoMed， PubMed， EMBASE， and the Cochrane Library. Studies that reported the treatment of blepharoptosis with frontalis muscle flap suspension and shortening of musculus levator palpebrae superioris were included. A random-effects model was applied to obtain the pooled odds ratio （OR） and 95% confidence intervals （CI） by STATA12.0. Results  19 articles（1 588 patients） were included in this study. There was no significant difference in the efficacy of shortening of musculus levator palpebrae superioris and frontalis muscle flap suspension for different degrees of ptosis （OR=0.97， 95%CI：0.50-1.86）. However， in terms of safety， frontalis muscle flap suspension had a higher incidence of complications （OR=2.34， 95%CI：1.19-4.61）. Further analysis of the two methods applied to the moderate and severe ptosis had shown that the efficacy of frontalis muscle flap suspension was still not significantly different from that of shortening of musculus levator palpebrae superioris （OR=0.73， 95%CI：0.35-1.53）， but the incidence of complications was further increased（OR=3.17， 95%CI：1.51-6.64）. Conclusion  The study indicated that the efficacy of frontalis muscle flap suspension in the treatment of blepharoptosis was comparable to shortening of musculus levator palpebrae superioris. However， the latter was safer and more reliable.

Key words： frontalis muscle flap suspension; shortening of musculus levator palpebrae superioris; blepharoptosis; Meta analysis; efficacy; safety; complications

上睑下垂是指由于各种原因导致上睑提肌和Müller平滑肌功能障碍，进而引起上睑部分或者全部下垂的一种常见疾病，大部分属于先天性，少部分也可由外伤或者其他因素引起[1]。临床上根据上睑缘遮盖角膜程度的不同，将其分为轻、中、重度，①轻度：遮盖≤4mm;②中度：遮盖4～6mm;③重度：遮盖>6mm，遮蓋达到瞳孔中央[2]。轻度患者临床表现为睑裂小、眼睛无神;而中、重度患者则可能出现弱视、斜视，额部皱纹增加，脊椎发育异常等症状，极大影响患者的生活质量[3-4]。本……