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目的 探讨A 型肉毒杆菌毒素联合手术治疗病程＞ 6 月的第六颅神经麻痹的方法和效果.方法 对21 例病程大于6 月的第六颅神经麻痹病人施行A 型肉毒杆菌毒素注射联合手术治疗, 其中注射3 ~28 个月后二期手术组13 例, 注射同期手术组8 例.分别行后退( 或联合肌肉边缘切开术)加截除术、直肌联结术或直肌转位术.结果 术后3 个月~1 年两组病人分别有11 例(84.62 ％ ) 及6 例(75 ％ ) 恢复正位, 平均矫正斜视度36.69 ˇ和71.25 ˇ; 二期组有2 例, 同期组有6 例正位病人恢复融合功能, 双眼注视野为20°~70°.结论 A 型肉毒杆菌毒素注射联合同期的肌肉联结术或肌肉转位术是病程＞ 6 月的第六颅神经麻痹理想的治疗方法, 其优点为可避免多条肌肉手术引起的前节缺血, 减少内直肌运动的限制, 并获得一定的融合功能.“,”Objective To investigate the methods and results of botulinum toxin A combined with surgery in the late stage sixth nerve palsy. Methods 21 patients with sixth nerve palsy in the late stage (morn than 6 months after onset) underwent botulinum toxin A injections and recession resection (some with marginal myotomy) or Jensen procdure or transposition of vertical rectus muscles. 13 of them had surgery 3 to 28 months after injections, 8 had surgery at the same time. Results 3 months to 1 year after surgery there were 11 (84 62%) and 6 (75%) obtained orthotropia in the two groups respectively, esotropia reduced averaging 36 69 PD and 71 25 PD respectively. 2 patients in the first group and 6 patients in the second group restored fusion and the fieldes of binocular single vision of 20°~70°. Conclusions Botulinum toxin A injection combined with surgery at the same time is the effective treatment for late stage of sixth nerve palsy. The advantages are avoidance of the risk of anterior segment ischimia in multiple muscles surgery and the reduction of medial rectus restriction and restoration of some fusion.