经鼻内镜手术治疗眶内海绵状血管瘤的效果分析  

Efficacy analysis of orbital cavernous hemangioma via endoscopic nasal surgery

作　　者：马晶影[1] 黄谦[1] 崔顺九[1] 姜利斌 杨本涛[3] 黄振校[1] 孙炎[1] 董怿[1] 周兵[1] Ma Jingying;Huang Qian;Cui Shunjiu;Jiang Libin;Yang Bentao;Huang Zhenxiao;Sun Yan;Dong Yi;Zhou Bing(Department of Otolaryngology-Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology and Head and Neck Surgery,Ministry of Education,Beijing 100730,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing 100730,China;Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科学与视觉科学北京市重点实验室,北京100730 [3]首都医科大学附属北京同仁医院影像中心,北京100730

出　　处：《眼科》2025年第2期123-129,共7页Ophthalmology in China

基　　金：国家自然科学基金(82171107);首都卫生发展科研专项基金(首发2020-1-2051)。

摘　　要：目的分析眶内海绵状血管瘤(OCH)内镜下经鼻手术效果。设计回顾性病例系列。研究对象2008年9月至2024年12月在北京同仁医院鼻科接受经鼻内镜手术的47例OCH患者。方法收集患者的一般资料、临床特征、检查结果、手术方式及转归,分析患者的临床特征及手术疗效。主要指标视力、视野、手术方式、手术时间及术中、术后并发症。结果47例OCH中肌锥外型12例、肌锥内型34例、视神经管内型1例。患者术前视力下降34例,视野缺损41例,眼球突出12例,复视4例,头痛/眼痛9例。35例肿瘤全切除,22例行筛骨垂直板眶壁重建;6例行眶减压及视神经减压术;1例行肿瘤部分切除、眶减压和视神经减压术;1例行眶减压及视神经减压术及瘤内注射博来霉素;2例行肿瘤部分切除及眶减压手术;2例单纯行眶减压术。术后平均随访(52.9±28.3)个月。术前34例视力下降患者的平均最佳矫正视力0.35±0.36,术后提高至0.56±0.38(P=0.001)。术前41例视野缺损患者中33例术后缺损范围明显减小,术前MD值为(-21.23±8.29)dB,术后改善至(-12.78±9.75)dB(P<0.001)。12例眼球突出的患者术后明显改善,眼球突出度由术前的(16.50±1.78)mm降至术后的(14.08±1.78)mm(P=0.002)。结论经鼻入路内镜手术治疗OCH是一种安全有效的方法。采用筛骨垂直板进行术后眶壁重建是经鼻内镜手术的优势。Objective To analyze the effect of endoscopic transnasal surgery for orbital cavernous hemangioma(OCH).Design Retrospective case series.Participants 47 patients with OCH who underwent endoscopic transnasal surgery in the Department of Rhinology of Beijing Tongren Hospital from September 2008 to December 2024.Methods General information,clinical characteristics,examination results,surgical approaches and outcomes of the patients were collected.The clinical characteristics and surgical efficacy of the patients were analyzed.Main Outcome Measures Visual acuity,visual field,surgical modality,operation duration and intraoperative and postoperative complications.Results Among the 47 cases of OCH,12 were extraconal,34 were intraconal,and 1 was intranervous.Before surgery,34 patients had decreased vision,41 had visual field defects,12 had exophthalmos,4 had diplopia,and 9 had headache or eye pain.Total tumor resection was achieved in 35 cases,and 22 cases underwent reconstruction of the orbital wall with the perpendicular plate of the ethmoid bone.Six cases underwent orbital and optic nerve decompression,1 case underwent partial tumor resection,orbital decompression,and optic nerve decompression,1 case underwent orbital decompression and optic nerve decompression with intratumoral injection of bleomycin,2 cases underwent partial tumor resection and orbital decompression,and 2 cases underwent only orbital decompression.The average follow-up period after surgery was(52.9±28.3)months.The preoperative mean best-corrected visual acuity(BCVA)in 34 patients presenting with visual impairment was 0.35±0.36,which improved to 0.56±0.38 postoperatively(P=0.001).Among 41 patients with visual field defects before surger,33 showed a significant reduction in the extent of the defect after surgery.The mean deviation(MD)improved from(-21.23±8.29)dB preoperatively to(-12.78±9.75)dB postoperatively(P<0.001).All 12 patients with exophthalmos demonstrated marked improvement,with exophthalmometry measurements decreasing from(16.50±1.78)m

关 键 词：内镜手术 眼眶海绵状血管瘤 

分 类 号：R73[医药卫生—肿瘤]