“非接触技术”切除联合带角膜缘的板层角膜移植术治疗角结膜恶性黑色素瘤  

Management of corneo-conjunctival malignant melanoma with“no touch technique” surgical excision and corneoscleral lamellar keratoplasty

作　　者：陈家祺[1] 孙明霞[1] 沙翔垠[1] 张平[1] 林跃生[1] 李辉[1] 刘永民[1] 陈龙山[1] 

机构地区：[1]中山大学中山眼科中心,广州510060

出　　处：《中华眼科杂志》2006年第1期22-26,共5页Chinese Journal of Ophthalmology

摘　　要：目的探讨“非接触技术”切除联合带角膜缘的板层角膜移植术治疗角结膜恶性黑色素瘤的临床效果.方法选择1989年10月至2004年1月在中山大学中山眼科中心就诊的6例（6只眼）角结膜恶性黑色素瘤患者,对患眼采用“非接触技术”行一次性整块切除肿瘤,术中避免手术器械与瘤体组织直接接触,结膜切除范围以带色素性结膜外4～6 mm为界,角膜切除区以肿瘤外2 mm为界,角膜和巩膜的切除深度以植床上无色素残留为准则.选择新鲜有活力的供体组织,同时行手术切除区的带角膜缘的部分板层角膜移植术或全板层角膜移植术,根据结膜切除的范围选择行联合羊膜移植术.术后密切随访6例患者,观察肿瘤复发和全身转移情况,随访间隔时间均不超过6个月.结果 6例患者均成功地施行了肿瘤局部切除术,同时行游离结膜边缘冷冻,其中3例为联合“带角膜缘的部分板层角膜移植术”,2例为联合“带角膜缘的全板层角膜移植术”,1例为联合“带角膜缘的全板层角膜移植＋羊膜移植术”.术后给予抗生素、糖皮质激素及免疫抑制剂眼液联合常规化疗,平均随访43.5个月（6个月至14.6年）,未见原位复发和全身转移发生.结论采用“非接触技术”一次性、完整地切除肿瘤,同时联合带角膜缘的板层角膜移植术,可以有效地治疗角结膜恶性黑色素瘤.Objective To study the management of ＂no touch technique＂ surgical excision and comeoscleral lamellar keratoplasty in the treatment of comeo-conjunctival malignant melanoma. Methods Surgical excision for comeo-conjunctival malignant melanoma in six cases, from October 1989 to January 2004 in Zhongshan Ophthalmic Center, were performed . The entire tumors were removed in one piece without touching the tumor （ no touch technique）. The incision was outlined 4-6 mm outside the pignented conjunctival mass, and 2 mm outside the corneal component. Dissecting deep enough without any tumor cell left to yield a tumor-free bed. After surgical incision, the host eyeball defect was covered with partial or total comeoscleral lamellar graft from fresh donor, and the conjunctiva defect was covered with or without anmiotic membrane transplantation. All the patients were followed up to 6 months. Results The tumors in the remaining conjunctival margins were completely removed by local dissection combined with cryotherapy in the six cases. Three cases were treated with partial comeoscleral lamellar keratoplasty, two cases with total comeoscleral lamellar keratoplasty and one case with total comeoscleral lamellar keratoplasty plus anmiotic membrane transplantation. All cases were subsequently treated with 0.01% thiotepa eyedrops and supplemental dacarbazine chemotherapy. At the average 43.5 months follow-up time （ 14. 6 years to 6 months）, no evidences of local recurrence of malignant melanoma or distant metastasis were observed. Conclusion The clinical study suggests that using surgical excision of ＂no touch technique＂ to remove tumor in whole piece with corneoscleral lamellar keratoplasty is effective in the treatment of corneoconjunctival malignant melanoma.

关 键 词：角膜疾病 眼肿瘤 黑色素瘤 角膜移植 

分 类 号：R739.7[医药卫生—肿瘤] R779.65[医药卫生—临床医学]