眼睑基底细胞癌的显微控制性手术治疗

Treatment of eyelid basal cell carcinoma with Mobs micrographic surgery

目的探讨眼睑基底细胞癌的显微镜下控制性切除的疗效。方法回顾性分析12例下睑基底细胞癌，行Mohs显微控制性切除联合眼睑缺损一期修复手术（包括：移行皮瓣、转移皮瓣或游离皮瓣及上睑移行睑板结膜瓣手术）。术后随访6个月-3年观察眼睑形态和功能，观察肿瘤复发情况。结果术中保留睑板者9例，术后皮肤切口对合良好，移行皮瓣、转移皮瓣及游离皮片均成活；其中早期转移皮瓣2例轻度隆起，术后3个月时平整；游离皮片早期色泽淡，稍后植片呈色素沉着改变，半年后逐渐恢复正常。眼睑全层切除3例，术后3个月时睑板红润，成活良好。全部病例术后眼睑外观大致满意，眼睑活动自如，闭合完全，无结膜或角膜暴露。无一例复发。结论Mohs显微控制性切除联合一期眼睑修复是一种安全有效的治疗眼睑基底细胞癌的手术方法。

Objective To investigate the efficacy of Mohs micrographic surgery in the treatment of eyelid basal cell carcinoma. Methods The data of 12 cases with lower eyelid basal cell carcinoma were collected and retrospectively analyzed. All cases underwent Mohs micrographic surgery combined with one stage repair of eyelid defect. The repair methods included sliding, rotation flap, free skin graft and upper eyelid tarsal conjunctival flap repaired surgery. Postoperative eyelid shape, function and tumor recurrence were observed 6 months-3 years after surgery. Results After surgery the skin incision of 9 cases retained tarsus intraoperatively was good. The sliding flap, rotation flap and free skin graft were all survived. Among them 2 cases of rotation flap were in the form of mild elevation in early time, they became flat and level 3 months after surgery. The color of free skin graft appeared light firstly, then became pigmentation deposit, it gradually returned to normal 6 months later. The tarsals were rosy and survived well after 3 months in 3 cases of full-thickness eyelid underwent resection. All the patients achieved satisfied appearance of the eyelids, the wound was healed, conjunctiva and cornea were not exposed. No recurrence occurred. Conclusion Mobs micrographic surgery combined with the reconstruction of eyelid is effective and safe for the treatment of eyelid basal cell carcinoma.