原发性泪腺上皮性肿瘤患者97例诊治分析

Diagnostic and therapeutical analysis of 97 cases of primary lacrimal gland epithelial tumor

目的探讨泪腺上皮性肿瘤的临床表现、影像学特征、诊断方法及治疗原则。方法对2003年1月至2014年10月在河南省眼科研究所就诊的97例泪腺上皮性肿瘤的临床表现、影像学检查、治疗方法、术后视力、及随访情况等临床资料进行回顾性分析。采用前路开眶11例,常规外侧开眶19例,改良"S"形皮肤切口并外侧开眶67例。结果 97例泪腺上皮性肿瘤中,泪腺多行性腺瘤65例(67.01%),腺样囊性癌16例(16.49%),多形性腺癌12例(12.37%),腺癌2例(2.06%),黏液表皮样癌1例(1.03%),肌上皮瘤1例(1.03%)。术后视力提高37例,无变化54例,下降6例。13例出现眼球内陷,早期上睑下垂11例,4例出现外展运动受限、水平复视。术后6个月随访:上睑下垂4例;1例出现永久性外展不足、水平复视。结论泪腺上皮性肿瘤具有典型的临床表现和特征性的影像学改变,术前通过准确的定位来选择适宜的手术进路,可顺利并完整地切除肿瘤,避免肿瘤复发和出现严重并发症。

Objective To investigate the clinical manifestations, characteristics of iconography, diagnostic methods and therapeutic principles of primary lacrimal gland epithelial tumor. Methods The clinical data on clinical manifestations, examinations of iconography,therapeutic methods,follow-up and so on of 97 cases of primary lacrimal gland epithelial tumor in Henan Eye Institute from January 2003 to October 2014 were analyzed retrospectively. Anterior orbitotomy was adopted in 11 cases, routine lateral orbitotomy for 19 cases, improved ＂S＂ shape skin incision and lateral orbitotomy for 57 cases. Results In 97 cases of primary lacrimal gland epithelial tumor, there were 55 cases （57.01%） for benign pleomorphic adenoma of lacrimal gland, 15 cases （ 15.49% ） for adenoid cystic carcinoma, 12 cases（ 12.37% ） for pleomorphic adenocarci- noma,2 cases（2.06% ）for glandular cancer,1 case （1.03%） each for mucoepidermoid carcinoma and myoepithelioma. Postoperative vision was improved in 37 cases, not changed in 54 cases, descented in 6 cases. Endophthalmos was found in 13 cases, early ptosis in 11 cases, abduction exercise limitation and horizontal diplopia in 4 cases. Fol- low up for 6 months after operation： ptosis appeared in 4 cases, permanent abduction insufficient and diplopia appeared in 1 case. Conclusions There are classic clinical manifestations and distinctive iconography changes in lacrimal gland epithelial tumor. By accurate localization before operation and selecting the proper surgical approach, the tumor can be excised successfully and completely, and the recurrence of tumor and severe complication also can be avoided.