原发性泪腺上皮性肿瘤25例临床分析

Clinical analysis for the diagnosis and treatment of 25 cases with primary lacrimal gland epithelial tumor

目的：探讨原发性泪腺上皮性肿瘤的临床表现、影像学特点、治疗方法。方法回顾性分析25例原发性泪腺上皮性肿瘤患者的临床资料。结果25例患者中，男14例，女11例；年龄23～65岁，平均44岁；住院时间7～20 d，平均12 d。25例均行手术治疗。术后病理诊断：泪腺炎性假瘤4例，泪腺多形性腺瘤7例，泪腺恶性多形性腺瘤4例，泪腺腺样囊性癌6例，泪腺腺癌4例。25例术后视力提高者9例，视力不变者10例，视力下降者6例，无视力意外丧失者。25例患者术后随访16～48个月，平均27个月，术后无瘤生存21例，失访2例，死亡2例。4例恶性肿瘤患者术后5～18个月复发，均行眶内容物摘除术，2例死亡（1例死于肝转移，1例死于颅内转移）。结论原发性泪腺上皮性肿瘤具有各自不同的临床表现及影像学特点。良性肿瘤多形状规则、生长缓慢，少有骨质吸收、破坏。恶性肿瘤生长迅速，且多见沿眶外壁向眶尖生长，易于侵犯邻近结构。彩超、CT、MRI 等影像学技术相结合，对原发性泪腺上皮性肿瘤的性质、病变范围和程度的确定有重要的临床意义。对于手术难度较易的原发性泪腺上皮性肿瘤须切除彻底，对于手术难度大、术后复发或有复发趋势的恶性泪腺上皮性肿瘤，伽马刀治疗是安全、有效的补充治疗方法。

Objective To explore the clinical manifestation,imaging features and treatment of primary lacri-mal gland epithelial tumor.Methods The clinical data of 25 cases with primary lacrimal gland epithelial tumors were retrospectively studied.Results All of 25 primary lacrimal gland epithelial tumor cases received surgical treatment. Fourteen primary orbital tumors cases were male and 11 cases were female.The mean age was 44 years old （ranged 23 to 65）.The mean hospital stay was 12d（ranged 7 to 20）.Among 25 primary lacrimal gland epithelial tumor cases, 11 cases were benign tumors which included 4 inflammatory pseudotumor,11 pleomorphic adenoma.Fourteen cases were malignant tumors which included 4 malignant pleomorphic adenoma,6 adenoid cystic carcinoma and 4 adenocar-cinoma.After opeation,visual acuity improved in 9 cases,unchanged 10 cases,decreased 6 cases.The patients were followed up for 16 -48 months（mean 27 months）.There were 4 malignant tumors recurrence after operation and received radical operation.While 2 patients were lost and 2 patients died of tumor metastasis,the other 21 patients survived with tumor -free.Conclusion Primary lacrimal gland epithelial tumors have different clinical and imaging appearances.Combination of ultrasound,CT and MRI is important to ascertain the character,range and degree of primary lacrimal gland epithelial tumors.Surgical excision is the main and effective treatment for primary lacrimal gland epithelial tumors,while gamma knife treatment is safe and effective for malignant,unresectable,recurrences tumors.