经骨膜下入路摘除眼眶海绵状血管瘤的疗效观察  

Therapeutic efficiency of transsubperiosteal approach for excision of orbital cavernous hemangiomas

作　　者：王毅[1] 李月月[1] 赵海萍[1] 丁琢[1] 肖利华[1] 

机构地区：[1]武警总医院眼眶病研究所,北京100039

出　　处：《中华眼科杂志》2013年第8期679-684,共6页Chinese Journal of Ophthalmology

摘　　要：目的探讨经骨膜下入路摘除眼眶海绵状血管瘤的适应证及手术效果。方法回顾性系列病例研究。对2004年6月至2010年6月在武警总医院眼眶病研究所手术并经病理学确诊的眼眶海绵状血管瘤（OCH）患者资料42例行回顾性分析。术前根据临床表现、CT及MRI影像学特征诊断为OCH。根据肿瘤发生部位分为4组：I组（18例），肿瘤位于眼眶颞上象限；Ⅱ组（15例），肿瘤位于眶上裂及周围的眶尖部；Ⅲ组（4例），肿瘤位于眶底部的周围间隙，深至眶尖；Ⅳ组（5例），肿瘤位于鼻下象限。4组均采用眶周皮肤切口，分离至眶缘骨膜后，经骨膜下人路摘除OCH。记录术后并发症和随访结果。结果术前诊断正确率100％。所有肿瘤均经一次手术彻底摘除，手术时间平均20～30min。38例（90．5％）完整摘除，4例（9．5％）分块取出。为扩大Ⅱ组眶尖部术野，6例（14．3％）截除眶外上方骨缘，3例（7．1％）使用磨钻磨除眶壁骨质。随访1～7年，影像学证实无肿瘤残留或复发，6例（14．3％）视力较术前提高。术后暂时性并发症包括：球结膜水肿9例（21．4％），眼球运动受限4例（9．5％）和3例上睑下垂（7．1％）。永久性并发症包括：眼球极限运动受限和瞳孔向心性扩大，各2例（4．7％）。结论经骨膜下入路适合摘除眼眶颞上、鼻下及眶底部等距骨壁较近且粘连不重的OCH，或眶上裂附近的OCH，手术安全有效，无严重并发症。Objective To evaluate the indications, operative skills and effects of transsubperiosteal approach for excision of orbital cavernous hemangiomas （OCH）. Methods In a retrospective study, the records of 42 cases with OCH confirmed by pathologic examination between June 2004 and June 2010 were analyzed. Preoperative diagnoses were based on clinical signs, CT and MRI examinations. According to the locations of the tumor, patients were assigned to 4 groups ： group Ⅰ： tumors located in the superotemporal quadrant in 18 cases; group Ⅱ ： tumors located in or near the superior orbital fissure in 15 cases; group Ⅲ ： tumors in the inferior peripheral space extending to the orbital apex in 4 cases; group Ⅳ： tumors in the inferonasal quadrant in 5 cases. In all 4 groups the periorbital skin was incised and then the periosteum of orbital rim was exposed. Tumors were removed from subperiosteal space. The complications and follow-up results were recorded. Results The rate of preoperative correct diagnosis was 100%. All cases were cured by once surgical procedures for average 20 -30 rain. Thirty-eight （90. 5% ） tumors were removed intact. The deblocking removal was recorded in 4 （9.5%） cases. In order to improve the surgical exposure of orbital apex in group Ⅱ , superolateral orbital rim was removed in 6 （ 14. 3% ） cases and the walls were drilled in 3 （ 7. 1% ） cases. Follow-up periods ranged 1 to 7 years. No recurrent or remnant was recorded on imaging reviews. The visual acuity was improved in 6 （14. 3% ） cases. The temporary complications included chemosis in 9 （21.4%） cases, limited ocular movement in 4 （9. 5% ） eases and ptosis in 3 （7. 1% ） cases. The permanent complications included limited ocular extreme movement and dilated pupil, both in 2 cases （4. 7% ）. Conclusions Transsubperiosteal approach is eligible for the removal of OCH in the superotemporal, inferonasal quadrant and the floor of the orbit and is recommended for thetumors near the superior orbital fis

关 键 词：眶肿瘤 血管瘤 海绵状 眼外科手术 骨膜 治疗结果 

分 类 号：R739.72[医药卫生—肿瘤]