教学手术录像分享：先天性下睑内翻手术矫正

原理

从下泪小点下方切除一个椭圆形皮肤和轮匝肌。皮肤边缘与下睑缩肌及睑板下缘缝合(Hotz型手术)。

适应症

持续性畏光并反复发作结膜炎的儿童有明显下睑内翻伴睑缘内翻，出生后两年内未消退。

方法

1.    用镊子夹起刚好矫正睑内翻的最小量的多余皮肤和轮匝肌。在眼睑内侧把它标记为椭圆。

2.    切除椭圆形皮肤和轮匝肌(图3.2a)。

3.    用长效6 '0'可吸收缝线间断缝合，将下睑皮肤边缘缝合到眼睑缩肌和睑板下缘(图3.2b)。

4.    双侧手术以形成对称的疤痕(图3.2c)。

5.    让缝线自然脱落。

并发症

很容易切除过多的组织，以至于以后造成睑外翻。

（以上文字翻译自《A Manual Of Systematic Eyelid Surgery 》第三版）

为了更好理解手术过程，网上找到相关手术讲解呈献如下。

Repair of congenital lower lid entropion

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This is Richard Allen at the University of Iowa. This video demonstrates repair of a unilateral congenital entropion. This appears be secondary to overriding anterior lamella. The posterior lamella appears normal without any evidence of shortening. A 4-0 silk suture is placed through the lower eyelid at the level of the tarsus in order to provide traction during the case. The second silk suture is then placed. A subciliary incision is then made with the 15 blade extending from the lateral canthus laterally to the level of the punctum medially. Westcott scissors are then used to dissect through the orbicularis muscle to identify the orbital septum. Needlepoint cautery is then used to dissect between the orbicularis muscle and the orbital septum towards the inferior orbital rim. The confluence of the lower lid retractors and orbital septum are then disinserted from the anterior surface of the tarsus. Dissection is then carried out between the lower lid retractors and the conjunctiva inferiorly. Redundant pretarsal orbicularis is then excised with the Westcott scissors. This is performed in order to lessen the override of the anterior lamella. Attention is then directed to the confluence of the lower lid retractors and orbital septum which is shortened. This is performed with the Westcott scissors. This will be incorporated into the skin closure in order to provide some downward traction on the anterior lamella. Attention is then directed to the palpebral orbicularis. This is also debulked with the Westcott scissors. Again this is performed with the thought that overriding anterior lamella is responsible for the entropion. The skin is then closed with interrupted 7–0 Vicryl sutures which incorporate the cut end of the orbital septum and lower lid retractors. This will provide a downward pull on the anterior lamella and create a relatively strong lower lid crease. This is performed along the length of the lid. At the conclusion of the case, the eyelid appears be in good position with a relatively prominent lower lid crease which will lessen with time.