结膜重度非典型增生局部癌变7例临床分析

Clinical analysis of conjunctiva severe dysplasia localized cancer in 7 cases

目的探讨眼结膜重度非典型增生局部癌变的临床特点及其治疗和预后。方法对我院眼科术后经病理检查确诊为结膜重度非典型增生局部癌变的7例（7眼）患者进行随访，随访1～15a，平均8．2a，对随诊及住院病历资料进行回顾性分析。7例结膜重度非典型增生局部癌变患者，其中3例行局部病变切除手术，对手术切除的瘤体行病理检查；4例行眶内容物摘出术。结果对手术切除的瘤体行病理检查结果显示：光镜下可见上皮的成熟仅限于表浅1／3，细胞核异型性显著的细胞从基底开始，超出中1／3进入上1／3。核分裂象多，可见于上皮各水平面，异常核分裂易见，胞浆量增多，嗜酸性增强，癌组织向间质浸润，形成不规则的癌巢，浸润细胞组成小芽，癌组织小芽浸润于间质中。3例行局部病变切除手术术后局部复发2例，再行眶内容物摘出术。4例行眶内容物摘出术后未见复发，未见其他部位转移。结论结膜重度非典型增生局部癌变的预防与解剖部位、累及范围、首次治疗方案等有关，早期诊断和选择最佳治疗方案是改善生存质量的重要手段。

Objective To investigate the clinical characteristics, treatment and prognosis of conjunctiva severe dysplasia localized cancer. Methods Seven patients （7 eyes） with conjunctiva severe dysplasia localized cancer were followed up, the fol- low-up time was from 1 year to 15 years,averaged 8.2 years,the extracted tumor tissues were pathological examined, and 4 cases received the intraocular eyeball extraction. Results The pathological examination showed that the flfll-grown epithelium only lo- cated in the one third of surface,the cells with obvious heteromorphism grew from the basement and invaded into the superior one third of layer; The karyokinesis were popu- lar seen in the each layer of epithelium, the abnormal karyokinesis also existed generally with more kytoplasm and strengthen acidophilia, the tumor tissues invaded into the sto- ma and formed the irregular cancer nest. Three cases received routine local lesion exci- sion,in which postoperative recurrence appeared in 2 cases and orbital contents enucle- ation was remade. Four cases received the orbital contents enucleation, no recurrence appeared and no distant transfer was seen. Conclusion The prevention of conjuncti-va severe atypical hyperplasia localized cancer is related with the anatomic site, scope, fist treatment, and early diagnosis and choosing the best treatment is the important means to improve their quality of life.