不同手术入路摘除眼眶海绵状血管瘤的效果  

Clinical outcomes of orbitotomy for orbital cavernous hemangiomas through different operative approaches

作　　者：沈亚[1] 高连娣[1] 程金伟[1] 蔡季平[1] 李由[1] 魏锐利[1] 

机构地区：[1]上海长征医院眼科,上海200003

出　　处：《上海医学》2013年第1期70-72,4,共3页Shanghai Medical Journal

基　　金：国家自然科学基金资助项目(81000374;81170874)

摘　　要：目的探讨不同入路手术摘除眼眶海绵状血管瘤的手术效果。方法回顾性分析189例经手术摘除的眼眶海绵状血管瘤患者的临床资料,对眼眶海绵状血管瘤患者的手术入路、手术技巧及手术效果进行总结。结果所有患者的海绵状血管瘤均经手术摘除。行经结膜入路前路开眶术121例,其中完整摘除肿瘤119例,肿瘤大部摘除2例;术后视力改善62例,视力稳定55例,视力丧失和减退4例(2例因大出血致视力丧失、2例因术中牵拉后瞳孔永久性散大而致视力减退)。行经皮肤入路前路开眶术25例,均完整摘除肿瘤,术后患者视力改善14例,视力稳定11例。行外侧开眶术37例,其中完整摘除肿瘤34例,肿瘤部分摘除3例;术后视力改善21例,视力稳定13例,视力丧失和减退3例(1例因术中损伤视神经致视力丧失、1例因术后发生视网膜中央动脉阻塞致视力骤降、1例因术中牵拉后瞳孔永久性散大而致视力减退)。行内外侧联合开眶术5例,其中完整摘除肿瘤3例,肿瘤大部摘除2例;术后视力改善1例,视力稳定3例,视力减退1例(因术中牵拉后瞳孔永久性散大而致视力减退)。内侧开眶术1例,完整摘除肿瘤,术后视力稳定。结论选择合适的手术入路可成功地摘除眼眶海绵状血管瘤。Objective To evaluate the clinical outcomes of different operative approaches for orbital cavernous hemangiomas. Methods The clinical data of 189 patients with orbital cavernous hemangioma who underwent ophthalmectomy were retrospectively analyzed. Surgical approaches and operative skills were evaluated with clinical outcomes. Results The tumors were treated by the surgical procedure. Transconjunctival orbitotomy was performed in 121 cases. The tumors were removed intact in 119 cases~ most fragments of tumors were incompletely removed in 2 cases. Visual acuity improved in 62 cases and was stable in 55 cases. Two patients suffered from permanent visual loss as a result of intraoperative hemorrhage and other two suffered from visual impairment because of mydriasis caused by operative drag. The tumors were removed successfully by percutaneous anterior orbitotomy in 25 cases, and visual acuity was improved in 14 cases and was stable in 11 cases. Lateral orbitotomy was performed in 37 cases~ there were 34 cases with complete resection and 3 cases with partial resection. Of them, visual acuity was improved in 21 cases, stable in 13 cases, and impaired in 3 cases （one of visual loss resulted from optic nerve injury during surgery, one of obvious decrease of visual acuity because of central retinal artery obstruction after surgery, and another of visual impairment because of mydriasis during surgery）. The tumors were treated by lateral-medial orbitotomy in 5 cases （3 cases with complete resection and 2 cases with partial resection）. Visual acuity was improved in one case, stable in 3 cases and impairment in one case because of mydriasis. The tumor was completely removed by medial orbitotomy in one case and the visual acuity was stable after surgery. Conclusion Orbital cavernous hemangiomas can be removed successfully through suitable operative approaches.

关 键 词：海绵状血管瘤 眼眶肿瘤 手术 

分 类 号：R739.7[医药卫生—肿瘤]