眼眶海绵状血管瘤诊断和治疗的临床分析

Clinical analysis of diagnosis and treatment of orbital cavernous hemangiomas

背景 眼眶海绵状血管瘤（OCH）是成人常见的原发于眼眶的良性肿瘤,术前准确的定性、定位诊断是安全、有效摘除肿瘤的重要前提. 目的 探讨OCH的临床特点、术前诊断、不同手术进路的适应证选择、治疗效果及并发症预防.方法 对2011年1月至2014年12月在河南省眼科研究所河南省立眼科医院接受手术治疗并经病理学检查确诊的OCH患者117例117眼的临床资料进行回顾性分析.患者分别于术前及术后接受视力、眼球突出度、眼球运动、眼眶扪诊、眼眶A型和B型超声、CDI、CT和MRI检查,并根据肿瘤在眼眶中的位置分别接受前路开眶术、外侧开眶术或外侧联合内侧开眶术.比较手术前后视觉功能和眼眶的形态学改变. 结果 OCH以渐进性眼球突出和视力下降为主要临床表现,117眼术前诊断与术后病理学诊断的符合率为100％.采用结膜入路者占52.14％ （61/117）,外侧开眶术者占30.77％ （36/117）,前路开眶皮肤切口术者占16.24％ （19/117）,外侧结合内侧开眶术者占0.85％ （1/117）.随访3个月～5年,影像学检查未见肿瘤残留和复发.术后视力较术前提高者占30.77％ （36/117）,下降者占8.55％ （10/117）,视力不变者占60.68％ （71/117）.术后一过性并发症为瞳孔改变者占14.53％ （17/117）,眶内大出血者占1.71％（2/117）,眼球运动障碍者占16.24％ （19/117）,上睑下垂者占4.27％ （5/117）;术后永久性并发症为瞳孔向心性扩大3眼及视力丧失和永久性外展运动受限各1眼. 结论 OCH术前定性和定位诊断主要根据临床和影像学检查,影像学检查结果有助于手术进路的选择,合适的手术方法和熟练的技巧对于OCH的治疗是安全且有效的。

Background Orbital cavernous hemangiomas （OCH） is a common benign orbital tumor in adult,and accurate localization and diagnosis before operation supports the significant premise for surgical safety and success of tumor extraction.Objective This study was to research the clinical characteristics,preoperative diagnosis,the selection for different surgical approaches,therapeutic effectiveness and complication prevention of OCH.Methods The clinical data of 117 eyes of 117 patients with OCH who received surgery were retrospectively analyzed.The patients received surgery in Henan Eye Institute,Henan Eye Hospital from January 2011 to December 2014 and followed-up for 3 months to 5 years.The visual acuity,exophthalmos,ocular movement,orbital A/B ultrasound,color Doppler image,CT and MRI were examined before and after surgery.Results The primary clinical manifestations of OCH were gradual exophthalmos and impaired vision.The accordance rate of preoperative diagnosis and pathological diagnosis was 100% in the group of patients.The surgical approachs included conjunctival approach in 52.14% （61/117）,lateral orbitectomy in 30.77% （36/117）,anterior approach in 16.24% （19/117） and lateral combined with medial approach in 0.85% （1/117）.At the end of followed-up,visual acuity was significantly improved in 30.77% （36/117）,declined in 8.55% （10/117） and unchanged in 60.68% （71/117）.Temporary complications after surgery were pupil dilatation in 14.53% （17/117）,emorrhoea in 1.71% （2/117）,ocular motility disorders in 16.24% （19/117） and ptosis in 4.27% （5/117）.The permanent complications after operation were pupil dilatation in 2.56% （3/117）,visual loss in 0.85% （1/117） and permanent abduction imitation in 0.85% （1/117）.Conclusions Accurate qualitative and site-specific diagnosis and correct choice of surgeries for OCH depend on clinical and iconographical examinations.Suitable surgical approach and operative skill are helpful to the therapeutic outcome and safety of OCH.