眼睑肿物临床病理分析及眼睑缺损修复探讨

Clinical and pathological analysis on eyelid tumors and repair approachs of the eyelid defect

目的分析眼睑肿物的临床及病理学分类，探讨手术方法及肿物切除术后跟睑及其周围组织缺损的修复。方法回顾性分析我院73例眼睑肿物基本资料、病理分类、治疗方式、治疗结果，探讨肿物切除术后眼睑缺损个体化修复方式。结果73例（73眼）眼睑肿物中，良性病变62例（84．9％），恶性肿瘤11例（15．1％）。良性病变类型中，以皮样、表皮样囊肿25例，基底细胞乳头状瘤12例，炎性肉芽肿6例，皮脂腺囊肿6例，皮内痣、混合痣5例等为多见。恶性病变中基底细胞癌9例，鳞状细胞癌2例。73例眼睑肿物均行手术切除，切除后眼睑缺损修复方法有：44例直接缝合切缘皮肤，15例游离松解切缘皮肤后对位缝合，5例取左上臂内侧皮肤植皮修复，7例行颧颞部皮瓣移植修复，1例行鼻唇沟皮瓣移植修复，1例行滑行睑板结膜瓣修复，植皮及皮瓣移植均成功存活，疗效良好。恶性肿瘤随访期间尚未见转移。结论眼睑肿物中良性病变多于恶性病变，恶性病变中以基底细胞癌最为常见，手术切除是治疗的有效方式，术后眼睑缺损的个体化修复重建在维持眼睑形态、防止眼睑畸形、保护眼表功能方面具有重要意义。

Objective To analyze the clinical type and the pathological classification of eyelid tumor, and investigate the method of surgical resections and the repair approaches for the eyelid defects fol- lowing extensive excision of eyelid tumor. Methods 73 eyes of 73 cases of eyelid tumor were retrospectively analyzed, according to histopathological diagnosis, treatment, prognosis, individual repair approaches for the eyelid defects. Results 62 cases were diagnosed with benign eyelid tumors, of which the common types are dermoid and epidermoid cyst, basal cell papilloma, granuloma, sebaceous cyst, intraderrnal nevi and com- pound nevi. 11 cases were with malignant tuomrs, including 9 cases of basal cell carcinoma and 2 cases of aquamous cell careinoma. All eyelid tumors underwent surgical resection, the repair approaches for the eye- lid defects were： direct suturing skin （44 cases） , suturing the release of cutting edge （15 eases） , skin graft fi＇om the inside of the left upper arm （5 cases） , lateral flap repairing （7 cases） , inside flap repairing （ 1 cases）, sliding tarsal eonjunctival flap （1 case）. All skin grafts and flaps were successful. During the followup, the malignant eyelid tumors hadn＇ t metastasized. Conclusion The majority of eyelid tumors is benign lesions. Basal cell carcinoma is the most common malignant lesions, surgical resection is an effective treatment. The repair approach for the eyelid defects following extensive exeison is importmant in maintaining eyelid shape, preventing eyelid deformities, keeping ocular surface function.