眼附属器结节病临床分析  

Clinical analysis of sarcoidosis of ocular adnexa

作　　者：卫承华[1] 钱江[1] 姚亦群[1] 袁一飞[1] 邬海翔[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中华眼科杂志》2010年第1期29-33,共5页Chinese Journal of Ophthalmology

摘　　要：目的探讨17例眼附属器结节病临床特点和诊断治疗经验。方法回顾性系列病例研究。回顾分析1993年1月至2008年10月在复旦大学附属眼耳鼻喉科医院治疗并经病理证实的17例眼附属器结节病患者的临床资料。结果男性4例，女性13例；年龄15～70岁，平均46．9岁；病变位于眼眶8例，泪腺5例，眼睑4例。14例主诉局部肿块，2例主诉眼球突出，1例主诉眼睑肿胀。并发肺部结节病3例，葡萄膜炎3例，皮肤结节病1例。6例中有4例血管紧张素转化酶增高，其中2例高于正常上限2倍以上。11例眼眶cT表现为中等密度实质性占位影，1例表现为低密度囊性占位影。5例B超表现为内回声均匀的低回声占位，1例表现为内回声不均匀的低回声占位。所有患者均经手术治疗，7例患者辅以糖皮质激素口服治疗。14例患者随访1至15年，无复发或再生长，3例失访。结论眼附属器结节病临床报道较少，多发生于中年女性，常表现为局部肿块，CT多表现为中等密度实质性占位，B超多表现为内回声均匀的低回声占位，应作为眼附属器占位性病变的鉴别诊断之一。病灶局限者可手术切除，病变广泛或并发全身病变者需辅以糖皮质激素治疗，并密切随访。Objective To study the diagnosis and treatment of 17 patients with sarcoidosis in ocular adnexa. Methods The clinical data of 17 cases with sarcoidosis in ocular adnexa treated during 1993 and 2008 were retrospectively analyzed. All patients underwent surgical treatment, and the diagnosis was proven histopathologically. Results Among the 17 cases, 4 were male, and 13 were female. The patients＇ age ranged from 15 to 70 years, with a mean of 46.9 years. The lesions were located at the orbit （8 cases）, lacrimal grand （5 cases） and eyelids （4 cases）. Fourteen cases complained of the presence of a local mass, 2 cases complained of exophthalmos and 1 swelling of eyelids. Concurrent systemic sarcoidosis was present in 7 cases. Three cases coincided with lung sarcoidosis, 3 cases with uveitis and 1 case with dermatopathy. Angiotensin converting enzyme analysis was performed in 6 cases; 4 of them were elevated. Computer tomography was performed in 12 cases; in 11 cases it presented as moderate density parenchymatous mass, and in the remaining one it presented as hypodensity cystic mass. B scan of 5 cases showed hypoechonic parenchymatous homogeneous mass. None of 14 cases relapsed after 1 to 15 years follow-up. Conclusions Ocular adnexal sarcoidosis usually presents as local mass and it should be included in the differential diagnosis of orbital and ocular adnexal lesions. Excision of localized mass alone could achieve satisfactory outcomes for isolated lesions, while for diffuse or systematic lesions, corticosteroid treatment should be prescribed routinely.

关 键 词：结节病 眶疾病 眼睑疾病 泪器疾病 

分 类 号：R739.7[医药卫生—肿瘤]