鼻内镜手术治疗ORBITⅢ期海绵状血管瘤:20例初步经验总结  

Endoscopic endonasal surgery for ORBIT stageⅢorbital cavernous hemangioma:a preliminary experience of 20 cases

作　　者：张秩荻 王毅[2] 周吉超[2] 杜雅丽[1] 左强[1] 姜海玲 张迎宏[1] Zhang Zhidi;Wang Yi;Zhou Jichao;Du Yali;Zuo Qiang;Jiang Hailing;Zhang Yinghong(Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing 100191,China;Department of Ophthalmology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院耳鼻喉科,北京100191 [2]北京大学第三医院眼科,北京100191

出　　处：《中华耳鼻咽喉头颈外科杂志》2025年第3期321-329,共9页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的评估经鼻眼眶手术技术分期(orbital resection by intranasal technique,ORBIT)Ⅲ期的眼眶海绵状血管瘤(orbital cavernous hemangioma,OCH)经鼻内镜手术切除的早期疗效和安全性。方法回顾性纳入2021年7月至2024年7月在北京大学第三医院接受鼻内镜手术切除ORBITⅢ期OCH的患者20例(20眼),男性10例,女性10例,年龄25~59岁,随访时间(5.10±4.51)个月。术前症状发生情况自高至低分别为视野缺损19例(95%)、视力下降18例(90%)、眼球突出2例(10%)、复视2例(10%)、头痛2例(10%)、眼痛2例(10%)、色觉异常1例(5%)。收集患者的人口学资料、病史、影像学资料、手术资料和随访结果,比较手术前后最佳矫正视力(best corrected visual acuity,BCVA)、视野、突眼度和眼压。手术入路采用单纯经鼻内镜OCH切除12例(60%),经鼻内镜联合结膜入路OCH切除8例(40%)。将术后2周复查结果作为术后短期疗效数据,术后3个月复查结果作为术后治疗效果数据。应用SPSS 26.0统计学软件进行统计学分析。结果20例患者的ORBITⅢ期OCH全部完整切除,患者术后BCVA、视野及突眼度明显改善,手术前后对比差异有统计学意义(t值分别为3.169、5.127和3.350,P值均<0.05)。术后短期均无眶内血肿、出血及视力丧失等严重并发症。单纯内镜术后短期并发症主要为新发复视1例(1/12),联合结膜入路术后短期并发症主要为新发复视5例(5/8)、瞳孔扩大2例(2/8),均于3个月内恢复,远期均无严重及永久并发症发生。结论经鼻内镜手术可安全有效地切除ORBITⅢ期OCH,早期效果良好。ObjectiveTo evaluate the early efficacy and safety of transnasal endoscopic surgical resection of orbital cavernous hemangioma(OCH)at orbital resection by intranasal technique(ORBIT)stageⅢ.MethodsA retrospective study was conducted on 20 patients(20 eyes)who underwent nasal endoscopic surgery to remove ORBIT stageⅢOCH at the Third Hospital of Peking University from July 2021 to July 2024.The cohort were included 10 males and 10 females,aged from 25 to 59 years,with a mean follow-up time of(5.10±4.51)months.Preoperative symptoms included visual field defects in 19 patients(95%),decreased visual acuity in 18 patients(90%),exophthalmos in 2 patients(10%),diplopia in 2 patients(10%),headache in 2 patients(10%),ocular pain in 2 patients(10%),and color vision abnormalities in 1 patient(5%).Data on patient demographics,medical history,imaging data,surgical approach,and postoperative outcomes were collected.Pre-and post-surgical outcomes including best corrected visual acuity(BCVA),visual field,proptosis,and intraocular pressure were compared.Surgical approaches included transnasal endoscopic OCH resection(12 cases,60%)and transnasal endoscopic combined conjunctival approach OCH resection(8 cases,40%).The results of the postoperative 2-week review were used as the postoperative short-term efficacy data,and those at 3 months were used for postoperative therapeutic efficacy analysis.SPSS 26.0 statistical software was applied for statistical analysis.ResultsIn 20 patients,all OCH were completely resected,and the BCVA,visual field,and exophthalmos were significantly improved post-operatively.The differences were statistically significant before and after surgery(t values were 3.169,5.127,and 3.350,respectively,all P<0.05).There were no serious complications in the short term after surgery.The short-term complications after endoscopic surgery alone were mainly new-onset diplopia in 1 case(1/12),and the short-term complications after combined approach were new-onset diplopia in 5 cases(5/8)and pupil dilation in 2 cases(2/

关 键 词：眶肿瘤 血管瘤 海绵状 内镜 外科手术 

分 类 号：R739.7[医药卫生—肿瘤]