原发性结膜淋巴增生性病变的临床特征及治疗预后分析  

Clinical features and prognosis of conjunctival lymphoid hyperplasia

作　　者：接英[1] 李上[2] 顼晓琳[3] 阮方[1] 李彬[3] 吕岚[1] 潘志强[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,北京100730 [2]首都医科大学附属北京佑安医院眼科,100069 [3]北京市眼科研究所北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730

出　　处：《中华实验眼科杂志》2016年第6期545-550,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目（81170824）

摘　　要：背景 原发性结膜淋巴增生性病变临床上症状不典型,容易造成误诊和误治,影响预后,因此了解其病变特征有重要的临床意义. 目的 分析原发性结膜淋巴增生性病变患者的临床特征及治疗预后.方法 采用回顾性系列病例观察研究方法,连续收集2012年1月至2014年12月北京同仁医院诊治的原发性结膜淋巴增生性病变20例患者的病历资料,分析其发病年龄、病变特点、治疗方法、预后、病理学检查结果和免疫组织化学检测结果,并评估不同类型的原发性结膜淋巴增生性病变的治疗方法和疗效.所有患者随访期均为1～2年.结果 原发性结膜淋巴增生性病变患者发病年龄为27 ～ 83岁,根据临床表现、病理学检查和免疫组织化学检测结果分为反应性淋巴细胞增生、不典型淋巴细胞增生和淋巴瘤3种类型,位于穹隆部结膜者占90％,结膜淋巴细胞反应性增生患者表现为结膜类滤泡形成;结膜淋巴细胞不典型增生患者表现为球结膜局限性粉红色增生,淋巴瘤患者多呈弥漫性鱼肉样外观.组织病理学检查可见结膜淋巴细胞反应性增生病变呈滤泡样增生组织,结膜淋巴细胞不典型增生者可见弥漫性淋巴细胞浸润,而结膜淋巴瘤组织可见弥漫性单核细胞样浸润;免疫组织化学检测可对3种类型进行鉴别.结膜淋巴细胞反应性增生性病变者采取观察和保守治疗,结膜淋巴细胞不典型增生和结膜淋巴瘤者行肿物切除联合结膜或羊膜移植术.随访期内未发现病灶复发.结论 原发性结膜淋巴细胞增生性病变临床表现多样,应与慢性眼表疾病相鉴别.病理组织学检查和免疫组织化学检测有助于不同类型病变的鉴别,应根据病变分型选择合适的治疗方法并进行长期随访,原发性结膜淋巴细胞增生性病变预后良好.Background Primary conjunctival lymphoid hyperplasia exhibit atypical clinical symptoms and easy to cause misdiagnosis and mistreatment.Understanding the clinical characteristics of primary conjunctival lymphoid hyperplasia is of an important clinical significance.Objective This study was to analyze the clinical characteristics and therapeutic outcome of patients with primary conjunctival lymphoid hyperplasia.Methods The medical records of 20 patients with primary conjunctival lymphoid hyperplasia who was treated in Beijing Tongren Hospital from January 2012 to December 2014 were retrospectively analyed.The age,symptoms,therapy,prognosis,histopathological features and immonochemistry results were reviewed,and the treating approach targeting to different types of conjunctival lymphoid hyperplasia was evaluated.The fellow-up duration was 1-2 years.Results Age of the patients ranged from 27 to 83 years old.The lesions were classified as benign lymphocytic hyperplasia,atypical lymphoid hyperplasia and lymphoma.Majority of lesions located in fornix conjunctiva tissue （90%）.Follicle-like appearance was seen in the benign lymphocytic hyperplasia,and pink elavation was exhibited at the bulbar conjunctiva in the atypical lymphoid hyperplasia.A diffuse salmon fish like appearance in conjunctiva was the primary feature of conjunctival lymphoma.Histopathological examination showed that conjunctival benign lymphocytic hyperplasia had follicle-like tissue in lesions,atypical lymphoid hyperplasia exhibited diffuse lymphocyte filtration,and conjunctival lymphoma appeared monocyte filtration.The 3 tpyes of lesions also could be differentiated by immunochemistry.The medicine was applied in the eyes with benign lymphocytic hyperplasia,and the combination of resection of lesions with conjunctival tissue or amniotic membrane transplantation was used for the atypical lymphoid hyperplasia or lymphoma eyes.No recurrence of the lesions was found during fellow-up duration.Conclusions The clinical manifestations of conjunctival lymphoi

关 键 词：结膜病变/病理 结膜新生物/诊断&治疗 增生 淋巴样组织/病理 淋巴瘤/病理 回顾性研究 人 

分 类 号：R777.3[医药卫生—眼科]