眼眶海绵状血管瘤的手术入路选择  

Surgical approaches for orbital cavernous hemangiomas

作　　者：程金伟[1] 魏锐利[1] 

机构地区：[1]第二军医大学附属上海长征医院眼科,200003

出　　处：《中华眼视光学与视觉科学杂志》2012年第5期264-266,共3页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：基金项目：国家自然科学基金（81070758,81170874）

摘　　要：目的探讨眼眶海绵状血管瘤经不同入路手术摘除的效果及其与影像学定位的关系。方法回顾性病例研究。分析164例经手术摘除的眼眶海绵状血管瘤患者资料．并对这些患者的手术入路、影像学特征、手术效果及其选择标准进行总结。结果经结膜入路者101例（占61．6％），位于肌锥内间隙，边界清楚且无明显黏连。经皮肤入路前路开眶者25例（占15．2％），位于肌锥外间隙，位置浅在。外侧开眶者32例（占19．5％），位于肌锥内间隙，均有较多黏连。内外侧联合开眶者5例（占3．0％），位于肌锥内间隙，形态不规则或者有较多黏连。内侧开眶者1例（占0．6％），位于内直肌内侧。156例患者肿瘤完整摘除，仅有2例视力丧失。另8例患者患者大部分切除。结论眼眶海绵状血管瘤可以通过选择合适的手术入路成功摘除。眼眶手术入路选择应根据病变性质、位置、范同而定。尽可能采取术野暴露清楚，损伤小，易于切除病变和外观良好的手术入路。Objective To evaluate the efficacy and selection criteria of different surgical approaches in patients with orbital cavernous hemangiomas. Methods It was a retrospective case series study, which included 164 patients with orbital cavernous hemangioma. The clinical and radiological characteristics of orbital cavernous hemangiomas were analyzed together with their surgical treatment and clinical outcomes. Results The following surgical procedures were used to treat the tumors： transconjunctival orbitotomy in 101 cases （61.6%） with roundish, well-defined intraconal masses; anterior orbitotomy in 25 cases （15.2%）, in which all tumors were situated extraconally and superficially; lateral orbitotomy in 32 cases （19.5%） with intraconal masses, adhering tightly to retrobulbar tissue; combined lateral and medial orbitotomy in 5 cases （3.0%） with intraconal masses, adhering tightly to retrobulbar tissue, or located on both sides of the optic nerve; and medial orbitotomy in 1 case （0.6%） with an extraconal mass located medially. In 156 cases, the tumors were removed intact, and only 2 patients suffered permanent visual loss. In another 8 cases, fragments of the tumors were incompletely removed. Conclusion Orbital cavernous hemangiomas can be removed successfully with different surgical approaches. The choice and approach depends on the nature, location, and extension of the tumors. The surgical approach is based on adequate exposure and visualization, easy removal of the lesions and excellent cosmetic results.

关 键 词：血管瘤 海绵状 眼眶 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]