眼眶神经纤维瘤的手术切除和即期整复

Removal and plastic reconstructive surgery of orbital neurofibroma

目的探讨眼眶神经纤维瘤的手术切除和即期整复治疗方法及其疗效。方法采用回顾性分析,选择2002年1月至2005年12月上海交通大学医学院附属第九人民医院眼科收治的26例(26只眼)眼眶神经纤维瘤患者,收集行肿瘤切除和即期整复治疗的临床资料和随访结果。按Jackson 分型法进行分型,其中Ⅰ型12例,Ⅱ型10例,Ⅲ型4例。肿瘤部分或次全切除后依据眼睑、眼眶畸形情况,分别对Ⅰ型患者行眼睑整复术,包括眼睑缩短、外眦韧带固定、外眦成形和上睑下垂矫正术。Ⅱ型患者行眼睑整复联合眼眶重建术,Ⅲ型患者行眼睑整复、眼眶重建联合羟基磷灰石(HA)眼座植入术或保留无视功能的眼球。术后随访12～30个月。结果26例患者行肿瘤部分或次全切除术后随访期内未见肿瘤快速生长。10例患者术后视力得到提高,12例患者视力保持不变。26例患者行眼睑整复术后外形良好,其中2例因上睑下垂复发再次手术。10例患者经眼眶重建术后眼眶外形和眼球突出度与对侧眼基本对称。2例患者行 HA 眼座植入术,2例患者保留无功能眼球,术后随访外观恢复良好。26例患者均未出现严重并发症。结论眼眶神经纤维瘤的部分或次全切除手术是完全有效的,依据肿瘤的不同类型进行即期眼睑、眼眶和眼球的整复手术,可获得外观和/或功能的共同改善。

Objective To investigate the safety and efficacy of surgical management of orbital neurofibroma (NF).Methods Twenty-six patients with orbitotemporal NF underwent tumor resection.And then 12 of the 26 patients that were of Jackson group 1,underwent blepharoplasty surgery,including lid plastic and reconstructive surgery,lateral canthal reattachment and ptosis surgery.Ten patients of group Ⅱ underwent blepharoplasty combined with orbital reconstruction.And 4 patients of group Ⅲ underwent blepharoplasty surgery,orbital reconstruction,and hydroxyapatite orbital implanting.The functionally useless eyes of 2 patients were retained for cosmetic appearance.Results There was no recrudescence after neurofibroma resection.10 patients had their vision acuity improved.All patients obtained satisfying results after eyelid and orbital plastic surgery.2 patients relapsed into ptosis that was cured with further frontalis suspension procedure with autogenous fascia lata.Conclusion Neurofibroma removal surgery is a safe and effective treatment method for NF patients.The periorbital appearance and visual acuity of patients with orbitotemporal NF can be significantly improved through oculoplastics surgery.