手术联合掺钕钇铝石榴石激光治疗眼眶静脉畸形  

Treatment of orbital venous malformation using surgical procedure combined with Nd： YAG laser

作　　者：范先群[1] 肖彩雯[1] 周国瑜[2] 贾仁兵[1] 傅瑶[1] 周慧芳[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院眼科,200011 [2]上海交通大学医学院附属第九人民医院口腔颌面外科激光室,200011

出　　处：《中华眼科杂志》2008年第8期681-686,共6页Chinese Journal of Ophthalmology

摘　　要：目的探讨手术切除联合掺钕钇铝石榴石激光（Nd：YAG）凝固治疗眼眶静脉畸形的有效性和安全性。方法回顾性系列病例研究。采用手术切除联合激光凝固的方法治疗眼眶静脉畸形患者17例。全身麻醉，根据瘤体部位、大小、与眼外肌和毗邻神经的关系，选择适当的手术径路，充分暴露瘤体，手术切除和激光凝固交替进行。激光凝固方式包括小剂量短时光凝和连续光凝，前者能量密度设定为60～80J／cm^2，后者能量密度不超过90～100J／cm^2。体积小、病变深，周围有重要的神经或血管时采用小剂量短时光凝；体积大、易暴露，且距重要的组织较远时用连续光凝。光凝后立即用低温生理盐水冲洗光凝部位予以降温，防止损伤周围正常组织。结果术后随访12～26个月，17例患者中疗效显著15例（88．24％），有效2例（11．76％），总有效率100％。术后所有患者无视力下降（2例视力提高），眼球突出完全矫正，其中4例出现眼球内陷，眼球运动明显改善。并发症包括：上斜肌麻痹1例，上险下垂1例。随访期内无一例复发或残存病变增大。结论手术联合Nd：YAG激光治疗眼眶静脉畸形是安全和有效的。激光凝固可减少术中出血，简便手术操作，降低手术风险，提高手术疗效。Objective To evaluate the security and efficacy of surgical procedure combined with Nd：YAG laser in the management of orbital venous malformation. Methods A total of 17 successive patients with orbital venous malformation were treated with surgical excision in conjunction with Nd：YAG laser from July 2003 to June 2005. General anesthesia was performed in all patients. Appropriate approach was used according to the location and size of the lesion as well as its relation with adjacent tissues. Surgical procedure and laser coagulation were performed alternatively. Intermittent or continuous photocoagulation aimed at minor and deep lesions or large and superficial lesions was administrated, respectively, when indicated. Laser power of these two procedures was set at 60 to 90 J/cm^2 or less than 100 J/cm^2, respectively. Cold saline solution was used to cool the targeted region immediately after photocoagulation in case of damage to surrounding normal tissues. Results Seventeen patients were followed-up for 12 to 26 months. Notable lesion regression was found in 15 cases and fair reduction of the lesion in 2 cases. Vision acuity decrease did not occur and vision acuity increase was found in 2 patients. Exophthalmos was completely corrected, enophthalmos was found in 4 patients, the movement of the eyeballs was markedly improved. Complications consisted of superior oblique muscle paralysis （ 1 case ） and ptosis （ 1 case ） . Relapse or aggravation of residual lesion was not found during the whole follow-up period. Conclusions Surgical procedure combined with Nd：YAG laser is a safe and effective procedure in managing patients with orbital venous malformation. Laser treatment can decrease the hemorrhage during operation, make the surgical procedure easier, reduce the risk of operation and improve the results of surgical treatment.

关 键 词：眼眶 静脉 畸形 眼外科手术 激光凝固术 

分 类 号：R686[医药卫生—骨科学]