眼睑基底细胞癌的手术治疗

Surgical treatment for eyelid basal cell carcinoma

目的观察眼睑基底细胞癌的手术治疗方法及疗效。设计回顾性病例系列。研究对象33例眼睑基底细胞癌患者。方法对患者分别实施标准切除术(17例)及Mohs显微切除术(16例)治疗,应用游离植皮及上下睑板移行修复加游离植皮修复缺损眼睑。随访观察患者手术后眼睑外观和功能,肿瘤复发率及患者的生存率。主要指标眼睑功能及肿瘤复发率与生存率。结果随访6个月～5年,平均2.5年。29例眼睑修复患者中,28例术后外观满意,1例因瘢痕较重出现下睑轻度外翻;11例游离植皮修复眼睑的患者术后皮肤色泽有差异,但半年内均恢复正常。29例术后眼睑运动基本正常。行标准切除术的病例中1例术后2年肿瘤复发,治愈率为94.12%,Mohs显微切除术的病例术后无1例复发,治愈率为100%;5年内,除1例死于心肌梗塞、1例死于脑血管疾病外,无因眼睑基底细胞癌死亡病例。结论手术切除是治疗眼睑基底细胞癌的有效方法,Mohs显微切除术效果优于标准切除术。肿瘤切除后,游离植皮、上下睑板的移行修复加游离植皮修复缺损的眼睑,可使眼睑恢复较理想的形态和功能。

Objective To observe the curative effect of surgical treatment for eyelid basal cell carcinoma. Design Retrospective case series. Participants 33 cases with eyelid basal cell carcinoma. Methods 33 cases with eyelid basal cell carcinoma treated with surgery, standard excision in 17 case and Mohs micro excision in 16 cases were analyzed, postoperative appearance and function of reconstructiiv eyelid, recurence rate and suivival rate were observed by follow-up survey. Main Outcome Measures Postoperative appearance, function of reconstructiiv eyelid, recurence rate and survival rate. Results After 6 month - 5 years follow-up survey with an average of 2.5 years, 28 of 29 cases obtained normal eyelid appearance, 1 case with lower eyelid gentle ectropium. 11 cases showed hyperpigmentation in skin-grafting area in early stage, and became normal in half a year. Eyelid function of 29 cases were normal. Tumour relapse was seen in one case 2 years after standard resection,the cure rate was 94.12%. No tumor relapse was seen in group of mohs micro resection, the cure rate was 100%. Within five years postoperation, there was no death case caused by basal cell carcinoma relapse, except one dying from myocardial infarction and another dying of cerebrovascular disease. Conclusions Operational excision is an effective approach for eyelid basal cell carcinoma. The effect of mohs micro resection is better than the one of standard resection. With dissociate skin grafting, fluctuate tarsal transmigration and dissociate skin grafting, eyelid appearance and function recover well.