目的：探究糖皮质激素联合手术方法治疗甲状腺相关性眼病(TAO)上睑退缩的临床疗效及预后。

方法：选取2014-02/2018-07于我院整形门诊及病房接诊的轻中度TAO上睑退缩患者96例146眼。根据治疗方式不同分为GI组：使用糖皮质激素治疗48例72眼； GS组：使用糖皮质激素联合结膜入路Müller肌切除术治疗48例74眼。比较两组患者治疗后上睑肌力、治疗效果、睑裂高度、实际上睑重睑宽度。

结果：治疗后，GI组患者有显著治疗效果32例47眼，无显著治疗效果16例25眼，GS组患者有显著治疗效果46例71眼，无显著治疗效果2例3眼，GS组患者的治疗疗效显著高于GI组(P<0.05)。术后GS组与GI组眼睑闭合不全无差异(P>0.05)。治疗前，GI组和GS组患者睑裂高度分别为11.25±1.85、11.31±1.46mm(P>0.05)，治疗后3mo，睑裂高度分别为10.14±1.23、8.52±1.01mm，GS组患者睑裂高度恢复情况优于GI组(P<0.05)。治疗前，GI组和GS组患者上睑肌力分别为15.34±2.13、15.26±1.78mm(P>0.05)，治疗后3mo，上睑肌力分别为15.64±1.34、14.36±1.56mm，两组患者上睑肌力无差异(P>0.05)。治疗前，GI组和GS组患者实际上睑重睑宽度分别为5.12±1.64、5.16±1.48mm(P>0.05)，治疗后3mo，实际上睑重睑宽度分别为7.67±2.95、8.49±2.39mm，GS组患者实际上睑重睑宽度改变距离优于GI组(P<0.05)。

结论：糖皮质激素联合结膜入路Müller肌切除术对TAO上睑退缩患者的治疗效果较佳，能够显著改善患者睑裂高度、实际上睑重睑宽度等。

METHODS: A total of 96 patients(146 eyes)with upper eyelid retraction who were admitted to the plastic surgery clinic and ward of our hospital from February 2014 to July 2018 were selected. According to different treatment methods, the patients were divided into GI group: 72 patients with TAO-related upper eyelid retraction treated with glucocorticoids; 72 patients with GS group: 48 patients with TAO-related upper eyelid retraction treated with glucocorticoid combined with conjunctival approach. After treatment, the upper eyelid muscle strength, the treatment effect, the height of the eyelid fissure, and the actual double eyelid width were compared between the two groups of patients.

RESULTS: After treatment, the patients in GI group had significant treatment effects in 32 people and 47 eyes, and the patients in the GS group had significant treatment effects in 16 and 25 eyes. The patients in the GS group had significant treatment effects in 46 cases and 71 eyes, and there were no significant treatment effects in 2 people and 3 eyes. Compared with the GS group, the treatment effect of the GS group was significantly higher than that of the GI group(P<0.05). There was no significant difference between GS group and GI group(P>0.05). According to the table, before treatment, the height of the eyelid fissures in the GI group and the GS group were 11.25±1.85 and 11.31±1.46mm, and the data in the two groups were similar(P>0.05). The height of the eyelid fissures was 10.14±1.23mm, 3mo after treatment was 8.52±1.01mm. Compared with the GI group, the recovery of blepharoplasty was better in the GS group than in the GI group(P<0.05). According to the table, before treatment, the upper eyelid muscle strength of the patients in the GI group and the GS group were 15.34±2.13 and 15.26±1.78mm, the data in the two groups were similar(P>0.05). Three months after treatment, the upper eyelid muscle strength was 15.64±1.34, 14.36±1.56mm. There was no significant difference in upper eyelid muscle between the GI group and the GS group(P>0.05). The results showed that before treatment, the patients with GI group and GS group actually had a double eyelid width of 5.12±1.64 and 5.16±1.48mm. The data in the two groups were similar(P>0.05). Three months after treatment, the double eyelid was actually The widths were 7.67±2.95 and 8.49±2.39mm, respectively. Compared with the GI group, the GI group had a better change in the double eyelid width than the GI group(P<0.05).

CONCLUSION: Glucocorticoid combined with conjunctival approach Müller myectomy is better for patients with upper eyelid retraction, which can significantly improve the height of the eyelid fissure and the width of the double eyelid.