结膜入路摘除眼眶海绵状血管瘤的临床效果观察  

Clinical observation on the efficacy of conjunctival approach for extirpation of orbital cavernous hemangioma

作　　者：巫颖杰 王方[2] 付志远 卜战云 Wu Yingjie;Wang Fang;Fu Zhiyuan;Bu Zhanyun(Department of Ophthalmology,Xiangcheng People’s Hospital,Xuchang 461700,China;Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]襄城县人民医院眼科,许昌461700 [2]郑州大学第一附属医院眼科,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2023年第12期943-948,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省医学适宜技术推广项目(SYJS2022143)。

摘　　要：目的评估眼眶海绵状血管瘤(OCH)结膜入路摘除的效果。方法回顾性病例系列研究。分析郑州大学第一附属医院2018年6月至2023年4月所有患者均行结膜入路眼眶摘除海绵状血管瘤术。观察经组织病理学检查确诊的OCH 33例(33眼)的临床资料。术前及术后视力(logMAR)、眼球突出度、眼球运动、上睑功能及瞳孔状态等;术后随访6个月并评价手术效果及其并发症。结果经内下方穹隆部结膜入路者16眼,经外下方穹隆部结膜入路者17眼。所有患者均一次手术完整摘除OCH,手术时间为(23.70±3.98)min,范围16~33 min。术后随访,视力提高者3眼(9.09%),视力下降者2眼(6.06%);一过性并发症包括上睑下垂1眼(3.03%),眼球运动障碍者15眼(45.45%),瞳孔散大者2眼(6.06%);永久性并发症包括眼球运动障碍者2眼(6.06%),瞳孔向心性散大者1眼(3.03%)。术前及术后最佳矫正视力(logMAR)分别为0.80(0.55,1.00)和0.80(0.50,1.00),差异无统计学意义(Z=-0.21,P=0.832);术前及术后眼球突出度分别为(16.00±2.25)mm和(14.00±2.39)mm,差异有统计学意义(t=-5.10,P<0.001);术前及术后存在眼球运动障碍者分别为14例和2例,差异有统计学意义(χ^(2)=0.05,P=0.002)。结论经结膜入路摘除OCH手术时间短,创伤小,并发症较少,是一种安全有效的手术方式。Objective To evaluate the efficacy of conjunctival approach extirpation of orbital cavernous hemangioma(OCH).Methods This was a retrospective case series study.The clinical data of 33 eyes of 33 patients with OCH diagnosed by histopathology from Jun.2018 to Apr.2023 in the First Affiliated Hospital of Zhengzhou University were analyzed.All cases received orbital cavernous hemangioma expirpation through conjunctival approach.Preoperative and postoperative examinations were performed,including visual acuity(logMAR),exophthalmia,eye movement,upper eyelid function,and pupil status.The results and complications were followed up and evaluated for 6 months.Results In this study,16 eyes were approached through the conjunctival of the inner lower fornix and 17 eyes were approached through the conjunctival of the outer lower fornix.OCH was completely removed in one operation for all patients,and the operation time was 16-33 minutes,with an average of(23.70±3.98)minutes.Postoperative visual acuity improved in 3 eyes(9.09%)and decreased in 2 eyes(6.06%).Transient complications included ptosis in 1 eye(3.03%),eye movement disorders in 15 eyes(45.45%),and dilated pupils in 2 eyes(6.06%).Permanent complications included eye movement disorders in 2 eyes(6.06%),and centripetal dilation in 1 eye(3.03%).The preoperative and postoperative best corrected visual acuity(logMAR)was 0.80(0.55,1.00)and 0.80(0.50,1.00).The difference was not statistically significant before and after surgery(Z=-0.21,P=0.832).The preoperative and postoperative exophthalmos were(16.00±2.25)mm and(14.00±2.39)mm and the difference was statistically significant(t=-5.10,P<0.001).Eye movement disorder existed in 14 cases and 2 cases preoperatively and postoperatively,and the difference was statistically significant(χ^(2)=0.05,P=0.002).Conclusion OCH resection via conjunctival approach is a safe and effective method with short operation time,less trauma and fewer complications.

关 键 词：摘除术 入路 结膜 血管瘤 海绵状 眼眶 并发症 手术 

分 类 号：R739.7[医药卫生—肿瘤]