改良经颅眶上外侧壁入路治疗眶尖区肿瘤的临床分析  

Surgical treatment of orbital apex tumors by refined transcranial orbitotomy through superolateral approaches

作　　者：赵军苍[1] 刘晓红[2] 王献明[2] 杨华堂[2] 苏钰清[2] 

机构地区：[1]邯郸市中心医院神经外二科,邯郸056001 [2]邯郸市中心医院,邯郸056001

出　　处：《中国肿瘤临床与康复》2014年第4期473-475,共3页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨改良经颅眶上外侧壁入路治疗眶尖区肿瘤的手术方法、适应证及效果。方法对2011年1月至2012年12月间经颅眶手术治疗的50例眶尖区肿瘤患者的临床资料进行分析。结果眶-翼点入路手术患者20例,眶-额与眶-颧以及颧-翼联合入路手术患者30例。肿瘤全切除35例(70.0%),肿瘤次全切除8例(16.0%),大部分或者部分切除6例(12.0%),活检1例(2.0%)。眶尖区肿瘤病理类型主要为脑膜瘤、神经源性肿瘤、血管/淋巴管源性肿瘤和泪腺源性肿瘤,分别占42.0%、32.0%、20.0%和6.0%。50例患者出院时,视力功能较治疗前有明显改善或无加重者20例,单纯眼睑下垂5例,眼球轻微活动受限7例(4例伴有眼睑下垂,3例复视),严重动眼神经损伤5例(1例神经鞘瘤,2例转移瘤,2例脑膜瘤),视力下降或者失明3例(2例视神经本身伴有肿瘤,1例颅眶沟通性神经鞘膜瘤)。术后6个月至1年随访观察显示,单纯眼睑下垂患者完全恢复,眼球轻微活动受限的临床症状完全消失,严重动眼神经损伤患者症状明显减轻,视力下降患者视力恢复正常。本组患者无复发和死亡。结论临床上采取改良经颅眶上外侧壁入路治疗眶尖区肿瘤是可行的,操作中应选取合适的角度,并加强神经功能的保护,降低并发症的发生,提高临床治疗总体效果。Objective To investigate the improvement of the lateral wall of transcranial supraorbital approach treating orbital apex tumor surgical methods, indications and results. Methods Clinical data of 50 cases with orbital apex tumor hospitalized from January 2011 to December 2012 receiving tran cranial orbital surgery were retrospectively analyzed. Results Orbital - period surgery in 20 patients, orbital - the amount and orbital - zeugmatic and zeugmatic - wing combined approach surgery 30 patients. Tumor resection in 35 patients, the proportion ofT0. 0% ; tumor subtotal resection in 8 patients, the proportion of 16. 0% ; most or partial resection in 6 patients, the proportion of 12.0% ; biopsy in one case, the ratio of 2.0%. Orbital apex tumor types mainly meningioma cases, Neutrogena tumors, vascular / lymphatic tumors, lachrymal gland tumors, the ratio was 42. 0%, 32.0%, 20.0 %, 6. 0 %. Target this group at discharge its visual function improved significantly compared to treatment or no increased 20 cases, five cases of simple posies, eye slight limitation of activity seven cases （4 cases with posies, diplopic 3 cases）, severe action five cases of optic nerve damage （ including one case of schwannoma, 2 cases of metastatic tumors, two cases of men- ingioma）, decreased vision or blindness in three cases （ two cases with optic nerve tumor itself, one case of crania-orbital nerve sheath tumors）. After 6 months to 1 year of follow-up observation, all patients were fol-lowed up 100. 0%. Simple posies patients fully recovered, mild eye symptoms completely disappeared activ- ity limitation, symptoms severe coulometer nerve injury significantly reduced visual acuity decreased vision returned to normal. This group of patients without recurrence and death. Conclusion Tran cranial supraor- bital approach treating lateral wall orbital apex tumor is feasible to operate due to the appropriate angle, the protection of nerve function and reduction of complications and improvement of the overall effectiveness of clinica

关 键 词：眶尖区肿瘤 颅眶上外侧壁入路 手术方法 治疗效果 

分 类 号：R739.7[医药卫生—肿瘤]