鼻内镜下改良泪前隐窝入路术式治疗泪囊原发性恶性黑色素瘤1例报告及文献复习  

Modified anterior lacrimal recess approach under nasal endoscope in treatment of primary malignant melanoma of lacrimal sac:A case report and literature review

作　　者：裴颖[1] 邹莹[1] 巴秀敏 李旭 PEI Ying;ZOU Ying;BA Xiumin;LI Xu(Department of Ophthalmology,Second Hospital,Jilin University,Changchun 130041,China)

机构地区：[1]吉林大学第二医院眼科,吉林长春130041

出　　处：《吉林大学学报（医学版）》2020年第4期863-866,I0009,共5页Journal of Jilin University：Medicine Edition

基　　金：吉林省科技厅优秀青年人才项目资助课题(3D518NW73429)。

摘　　要：目的:分析鼻内镜下改良泪前隐窝入路术式治疗泪囊原发性恶性黑色素瘤患者的临床效果,以提高临床医生对该病及术式的认识。方法:收集1例原发性恶性黑色素瘤患者的临床资料、影像学表现和病理资料,分析改良泪前隐窝入路术式治疗该病的优点,结合相关文献总结其临床诊断标准和治疗方法。结果:患者,女性,53岁,右眼流泪2年,内眦处肿物6个月,门诊以“泪囊肿物”收入院。患者右眼内眦部触及肿物,大小约1.7 cm×1.2 cm×1.0 cm,质韧,边界不清,压痛,与周围皮肤紧密黏连,挤压泪囊区,少许血性分泌物自泪点溢出。冲洗泪道,原泪点返流。眼眶CT检查显示右侧泪囊内高密度影、右侧泪囊区及鼻泪管内高密度影且右侧泪囊明显增大。初诊为右侧泪囊及鼻泪管占位性病变。采用鼻内镜下改良泪前隐窝入路术式完整切除肿瘤,术后病理显示为恶性黑色素瘤累及周围肌肉组织。结论:鼻内镜下改良泪前隐窝入路术式治疗泪囊原发性恶性黑色素瘤具有术野暴露好、微创、易于操作和低风险等优势。Objective:To analyze the clinical effect of the modified anterior method in the treatment of the patient with primary malignant melanoma of lacrimal sac,and to improve the clinician’s understanding of the disease and operation method.Methods:The clinical materials,imaging founding and pathological data of one patient with primary malignant melanoma were collected,the advantages of the modified anterior lacrimal recess approach in the treatment of the disease were analyzed,and the clinical diagnosis criteria and treatment methods were summarized combined with the relevant literature review.Results:The female patient,aged 53 years old,had tears in her right eye for 2 years and tumor in her inner canthus for 6 months and was admitted to the hospital because of tumor of dacrycyst.The tumor was found in inner canthus of the right eye of the patients,which was about 1.7 cm×1.2 cm×1.0 cm in size,with tough texture,unclear boundary,tenderness,and close adhesion with the surrounding skin;when the lacrimal sac area was squeezed,a little blood secretion overflowed from the lacrimal spot.The lacrimal passage was washed and the flushing fluid was flowed back in the original lacrimal point.The orbital CT results showed high density shadow in the right lacrimal sac,high density shadows in the right lacrimal sac area and nasolacrimal duct,and obvious enlargement of the right lacrimal sac.The primary diagnosis was right lacrimal sac and nasolacrimal duct space occupying lesions.Modified anterior lacrimal recess approach under nasal endoscope was used to remove the tumor completely.The postoperative pathology showed that the malignant melanoma involved in the surrounding muscle tissue.Conclusion:The modified anterior lacrimal recess approach under nasal endoscope has the advantages of good field exposure,minimal invasive surgery,easy to operate and low risk.

关 键 词：鼻内镜 改良泪前隐窝入路术式 泪囊 原发性恶性黑色素瘤 

分 类 号：R739.7[医药卫生—肿瘤] R730.261[医药卫生—临床医学]