眼睑结膜淀粉样变性临床病理学特征及手术疗效

Clinical and pathological features and surgical treatment of eyelid/conjunctival amyloidosis

目的 总结并探讨眼睑结膜淀粉样变性的临床病理学特征及手术治疗效果.方法 回顾性系列病例研究.收集整理2007年2月至2015年10月北京同仁医院眼整形科手术治疗并经病理检查确诊的11例眼睑结膜淀粉样变性患者的临床和组织病理学资料,并进行分析.病理学检查采用常规石蜡切片,HE染色和刚果红染色.11例患者均接受手术治疗.7例伴有上睑下垂的患者行眼睑结膜肿物切除联合上睑下垂矫正术.1例下睑肿胀增厚的患者行眼睑结膜肿物切除联合下睑成形术.1例上睑肿物的患者行上睑肿物切除术.2例单纯结膜病灶的患者行结膜肿物切除术.结果 11例患者中男性6例,女性5例,就诊年龄13～59岁,平均年龄31岁,中位数年龄21岁.8例为眼睑肿胀增厚、结膜结节状肿物,其中7例伴有上睑下垂;1例为上睑肿物;2例为半月皱襞结膜肿物.全身检查未发现系统性淀粉样变性.11例患者均接受手术治疗,切除眼睑结膜病灶,其中7例联合上睑下垂矫正术.手术标本组织病理学检查均诊断为淀粉样变性.随访时间1～9年,9例患者病情稳定,1例结膜病变进展,1例失访.结论 眼险结膜淀粉样变性多表现为眼睑结膜肿块或弥漫增厚,手术治疗效果多较为满意.

Objective To study the clinical and pathological features and surgical outcome of eyelid/conjunctival amyloidosis.Methods It was a retrospective case series study.The clinical and pathological records of 11 patients who were diagnosed as eyelid/conjunctival amyloidosis and had surgical treatment between February 2007 and October 2015 at Beijing Tongren Hospital were analyzed.Routine pathological examinations and Congo red staining were performed.All of the 11 patients received surgical treatment.Seven patients with ptosis underwent surgical excision and ptosis repair.One patient with lower eyelid mass underwent surgical excision and reconstruction of the lower eyelid.One patient with upper eyelid mass underwent surgical excision.Two patients with conjunctival mass underwent surgical excision.Results In the 11 patients,6 were male and 5 were female.The mean age was 31 years old,median age was 21 years old,and the range of age was13-59 years old.Eight cases presented as eyelid thickening and nodular growth of the conjunctiva,and 7 of them had ptosis.One case presented as tumor of the upper lid.Two cases presented as conjunctival masses at the semilunar fold.None of the patients were found to have systemic involvement.All of the 11 cases received surgical treatment including excision of the lesions and correction of ptosis when necessary.Pathological examinations confirmed the diagnosis of amyloidosis.Follow up time was 1-9 years.Nine cases were stable,1 case had progression in the conjunctival lesion and 1 case was lost to follow up.Conclusions Eyelid/conjunctival amyloidosis usually present as mass or diffuse thickening of the eyelid/conjunctiva.The outcome of surgical treatment was satisfying.