泪腺多形性腺瘤96例临床特征及摘除手术方法研究

Clinicgl characteristics and methods of extirpating surgery of 96 cases with lacrimal gland pleomorphic adenoma

目的研究泪腺多形性腺瘤临床特征及摘除手术。方法对96例进行回顾性分析。分析其临床特征、摘除手术方法及术后复发情况。结果术后病理学证实96例均为泪腺多形性腺瘤。其中原发性者74例，复发性者22例。原发性泪腺多形性腺瘤中，常见的症状和体征依次为眼球突出56例（75．7％），眼球移位40例（54．1％），眼球运动受限37例（50．0％），视力下降9例（12．2％），复视4例（5．4％），疼痛3例（4．1％）。复发性多形性腺瘤中，常见的症状和体征依次为眼球突出16例（72．7％），眼球移位13例（59．1％），视力下降9例（40．9％），眼球运动受限7例（31．8％），复视6例（27．3％），疼痛4例（18．2％）。术后随访3～10年，74例原发病例术后复发1例（1．4％）。22例复发病例术后再次复发者3例（13．6％），恶性变2例（9．1％），死亡1例（4．5％），失访2例（9．1％）。结论术前对肿瘤进行精确定位，对其大小、边界、范围、质地及与周围组织的关系进行仔细研究，选择最合理的手术入路。避免术前活检。

Objective To investigate the clinical characteristics and extirpating surgery for lacrimal gland pleomorphic adenoma. Methods Ninty-six cases of benign pleomorphic adenoma of lacrimal gland were retrospectively studied. The clinical characteristics, extirpating procedure and postoperative recurrence were analyzed. Results All of the patients were confirmed pleomorphic adenoma of lacrimal gland by the pathological examination after the surgery. Of all 96 cases, 74 cases were primary ones and 22 cases were recurrent ones. The common symptoms and signs of primary pleomorphic adenoma were exophthalmos （56 cases, 75.7% ）, ectopia bulbi （40 cases, 54.1% ）, limitation of eyeball movement （37 cases, 50.0% ）, decreased visual acuity （9 cases, 12.2% ）, diplopia （4 cases, 5.4% ） and pain （3 cases, 4.1% ）. The common symptoms and signs of recurrent pleomorphic adenoma were exophthalmos （ 16 cases, 72.7% ）, eetopia bubli （ 13 cases, 59. 1% ）, decreased visual acuity （9 cases , 40.9% ）, limitation of eyeball movement （7 cases, 31.8% ）, diplopia （6 cases, 27.3% ） and pain （4 cases, 18.2% ）. The patients were followed up for 3 - 10 years. In the 74 primary cases, 1 case recurred （ 1.4% ）. In the 22 recurrent cases, 3 cases recurred （13.6%）, 2 cases had malignant change （9.1%）, 1 case died （4.5%）, and 2 cases were lost to follow-up （9. 1% ）. Conclusion Before the operation for lacrimal gland pleomorphic adenoma, the tumor should be accurately located. The size, boundary, range, texture and the relationship with the surrounding tissue should be carefully studied for selecting the reasonable surgical procedure. The biopsy should be avoided.