眼附属器MALT结外边缘区B细胞淋巴瘤临床分析

Clinical analysis of ocular adnexal mucosa-associated lymp-hoid tissue lymphoma

目的探讨眼附属器包括眼睑、结膜、眼眶和泪腺等部位MALT淋巴瘤的临床诊断要点、影像学检查特征及治疗和预后。方法回顾性分析1994年至2005年45例病理确诊的眼附属器MALT淋巴瘤患者的影像学和免疫学检查结果、治疗经过、疗效分析及预后情况。结果B超能较好的显示病变内部结构和形态;CT对眶骨结构、肿瘤侵犯范围、与周围组织的关系显示良好,具有定性诊断价值;MRI对软组织的分辨力强,成像参数根据不同的信号强度可提示病变的内部结构。45例均行手术治疗,其中22例辅以放疗,10例结合化疗。42例随访4～135个月,3例复发,1例于手术切除后25个月转移至肺而死亡,其余均存活,总生存率为97.7%,复发率为6.6%.结论眼附属器MALT淋巴瘤好发于眼眶上方及眼睑。影像学检查对MALT淋巴瘤的诊断和鉴别诊断有帮助;B超、CT、MRI检查能提供较好的定性、定位诊断。手术切除肿瘤,结合放疗、化疗能取得较好的疗效。病变可长期局限,预后一般较好,不会出现全身转移和向弥漫性大细胞高度恶性淋巴瘤转化。

Objective To study the methods of preoperative diagnosis,characteristic of imaging examination, treatment and prognosis of mucosa-associated lymphoid tissue （MALT） lymphoma in the ocular adnexa including conjunctivea, eyelids, lacrimal glared and orbit. Methods The results of imaging and immunological examination, process of treatment, analysis of curative effect and prognosis in 45 cases of ocular adnexal MALT lymphoma were analyzed retrospectively 1994 to 2005. Results B mode hypersound had a better value to display internal structure and shape of the lymphoma;CT could discover the structure of orbit and the relation between infiltrative region and Ambient tissue,had the qualitative value to dtagnosis;MRI had strong discrimination of the soft tissue, imaging parameter based on different signal tntensity to reveal internal structure of the lymphoma. All 45 cases were treated by surgery, combined with radiotherapy in 22 cases and chemotherapy in 10 cases. The follow-up time in 42 cases was range from 4 to 135 months,3 cases recurred,and 1 case died at 25 months for lung trans, ferret, the total living nnd recurrence rate were 97.7% and 6.6% respectively. Conclusion The ocular adnexal MALT lymphoma is commonly locnlized superior part of the fossa orbttalis and eyelids. Imaging examination is helpful to correct and differential dtagnosis. Surgery combined radiotherapy nnd chemotherapy can receive better curative effect. The tumor can COnfine to local region and seldom transforms to high-grade malignant lymphoma and other region in body. [ Rec Adv Ophthalmoi 2007 ;27（2） ：116-119]