顕微鏡下の眼瞼下垂手術（1）—CO2レーザーの併用—

Microscopic Blepharoplasty: Combined Use of CO2 Laser

はじめに

　手術の基本は術野をよく見て，解剖を理解したうえで施術を行うことである。手術用顕微鏡の使用は肉眼で見るよりもさらに鮮明に解剖を把握することができるので，手術の質の向上に大きく貢献する。

　本稿では，われわれが30年以上にわたって行ってきた顕微鏡下の眼瞼手術について述べる。

　The advantages of using an operating microscope in a blepharoplasty are as follows. (1) A bright and magnified view (usually 4×) is obtained, making it easier to grasp the delicate anatomy of the eyelid. (2) Understanding the anatomy allows for efficient dissection and hemostasis, which leads to shorter operating times. (3) In difficult blepharoplasty cases in which the eyelid tissue is very thin or the eyelids are puffy with thick fat, it can be hard to determine the appropriate layer to dissect, but this is easy to do under a microscope. (4) Although a surgeonʼs visual ability may decrease with age, as long as surgery is performed under a microscope the surgical field can be clearly seen, which helps maintain and improve the quality of surgeries. (5) The microscope image can be viewed directly on a computer monitor and recorded, which is useful for learning and teaching surgical techniques. The images can also be effectively used for presentations at medical conferences. (6) Since the surgeonʼs posture while using a microscope is natural, it is less likely to cause neck pain, which is a problem when loupes are used for a long time.

　The advantage of the CO₂ laser is that it can cut tissue very sharply and causes little bleeding. We believe that use of a CO₂ laser under an operating microscope for eyelid surgery is the best combination to achieve good results within a shorter operating time.