保留眼球的眶周侵袭性恶性肿瘤切除及修复  

Resection and repair of periorbital invasive malignant tumors with preserved eyeballs

作　　者：田艳明 高雯 闫希东 李鹏[1] 杨胜 高晓唯 TIAN Yan-Ming;GAO Wen;YAN Xi-Dong;LI Peng;YANG Sheng;GAO Xiao-Wei(From the Department of Ophthalmology,Xinjiang Military Region General Hospital Beijing Road Clinical Department,Urumqi 830012,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆军区总医院北京路临床部眼科,新疆维吾尔自治区乌鲁木齐市830012

出　　处：《眼科新进展》2019年第11期1080-1083,共4页Recent Advances in Ophthalmology

摘　　要：目的总结保留眼球及个体化皮瓣修复用于治疗眶周侵袭性恶性肿瘤的手术治疗效果及预后。方法回顾性分析2007年3月至2016年3月我院收治的14例(14眼)眼睑及眼眶侵袭性恶性肿瘤,手术完整切除肿瘤,残留结膜或皮瓣覆盖眼球,个体化皮瓣修复缺损,对该手术治疗方法的效果进行分析。结果14眼中眼睑基底细胞癌3眼,鳞状细胞癌4眼,皮脂腺癌6眼,横纹肌肉瘤1眼。14例恶性肿瘤均完整摘除,1例治疗20个月后死亡,1例复发性横纹肌肉瘤放弃继续治疗,1例术后放疗后无光感,皮肤溃疡角膜暴露,其余患者随访2~5 a均无复发,创面愈合良好,皮瓣下眼球运动良好,光感存在。结论眶周侵袭性恶性肿瘤较为罕见,肿瘤扩大性切除后可以采取保留眼球的手术方式,并根据缺损范围选择合适的皮瓣修复,可以减少创伤,简化手术操作,保留一定外观。血管吻合皮瓣修复应慎重应用于该类侵袭性肿瘤患者中。Objective To summarize the surgical treatment effects of preserved eyeballs and individualized flap repair for the treatment of orbital eyelid invasive malignant tumors.Methods Retrospective analysis of 14 patients(14 eyes)with invasive malignant tumors of eyelid and orbit treated in our hospital from March 2007 to March 2016 after complete surgical resection of the tumor,residual conjunctiva,or flap covering the eyeball and individual flap repair was performed.Results In the 14 eyes,there were 3 eyes with basal cell carcinoma of eyelid,4 eyes with squamous cell carcinoma,6 eyes with sebaceous adenocarcinoma and 1 eye with rhabdomyosarcoma.All 14 patients of malignant tumors were completely removed,but one patient died after 20 months of treatment.One patient with recurrent rhabdomyosarcoma declined further treatment.One patient had no light perception after postoperative radiotherapy and developed skin ulcers and corneal leakage.The remaining patients were followed up for 2 to 5 years without recurrence;the wounds healed well,the eyeballs under the flaps had good movement,and light perception was present.Conclusion Invasive orbital and eyelid tumors are rare.The eyeballs can often be preserved after complete tumor resection.Appropriate flap selection according to the defect range can reduce trauma,simplify the operation and preserve the appearance.However,flaps with vascular anastomoses should be carefully applied to such patients.

关 键 词：眼眶 侵袭性恶性肿瘤 放射治疗 保留眼球的切除术 

分 类 号：R777.5[医药卫生—眼科]