无蒂型结膜乳头状瘤临床分析

Clinical analysis of patients with non-pedunculated conjunctival papilloma

目的分析和探讨无蒂型结膜乳头状瘤的临床和病理特征、治疗方法及其疗效。方法对23例(23眼)无蒂型结膜乳头状瘤患者的临床、病理资料及手术方法进行回顾性分析。结果23例患者均经病理证实为结膜乳头状瘤,其中3例还可见鳞状上皮细胞呈巢状或团块状浸润性生长,提示癌变。对23例患者均进行术后随访,时间为2～5年,平均随访时间为(4.6±1.6)年,无1例失访。在行羊膜移植的21例患者中,76.2%(16/21)在羊膜术后4周内吸收,14.3%(3/21)在第5周吸收,9.5%(2/21)在第6周吸收。术后矫正视力>1.0有7例,0.3～1.0有15例,<0.3有1例。随访期间所有患者均未复发。21.7%(5/23)的患者出现角膜周边混浊,主要因病变组织范围较大,从角巩缘长入角膜周边浅基质层间,组织修复后可见角膜周边混浊,但不影响视力。4.3%(1/23)的患者在外眦角附近出现轻度睑球粘连,系结膜缝线过早脱落所致,对眼球视功能、运动和外观无影响。所有患者均未出现严重并发症。结论无蒂型结膜乳头状瘤有癌变倾向,显微手术切除联合羊膜移植是有效的治疗方法。

Objective To investigate the clinical, pathological features and the treatment of non-peduncu- lated conjunctival papilloma （NCP）. Methods The clinical and pathological data of 23 patients （23 eyes） with UCP were retrospectively analyzed. Results All patients were confirmed of UCP pathologically, and 3 cases had squamous epithelium with a nest and plump infiltration appearance, indicating malignant transformation. The follow-up time was from 2--5 years, with a mean of （4.6±1.6） years. Twenty-one patients were treated by excision using microsurgery combined with amniotic membrane grafting. Amniotic membrane of 16（76.2 %） cases were absorbed within 4 weeks postoperatively, 3 within 5 weeks, and 2 within 6 weeks. Postoperatively, 7 patients had a corrected vision 〉1.0, 5 had a vision of 0.3--1.0, and 1 had a vision of 〈0.3. All cases were cured by primary treatment without recurrence. Postoperative complications included corneal opacity without visual impairment in 5 cases （21.7%）, mild symblepharon in 1 case （4.3%, with no influence on the vision function, movement, and appearance）. No serious complication was found. Conclusions NNP has a tendency of malignant transformation; excision by microsurgery combined with amniotic membrane grafting is an effective method for treatment of NNP. （Shanghai Med J, 2008, 31~ 317-319）