眼眶神经鞘瘤112例的诊断和治疗分析

Diagnostic and therapeutical analysis of orbital neurilemomas

目的总结眼眶神经鞘瘤的临床表现、影像学特征、诊断及治疗原则。方法回顾性系列病例研究。收集2002年1月至2016年12月在天津市眼科医院经手术治疗和病理组织学检查证实的眼眶神经鞘瘤112例。对其临床症状、眼部体征、影像学检查、诊断、治疗及预后进行分析。采用SPSS 21.0软件对年龄、随访时间进行统计学描述。结果112例中男性48例，女性64例，就诊年龄13~73（40±4）岁。其中行B型超声检查112例，可见眼眶内圆形、类圆形、串珠状或不规则占位病变，边界多较清楚。内回声较弱，透声性强，有轻度可压缩性；行CT检查112例，肿瘤形状呈椭圆形、分叶状、S形或花生状，多数肿瘤内密度为均质高密度，少数肿瘤内有低密度液化区；MRI成像54例，T1加权像（T1WI）显示肿瘤全部为中信号，T2加权像（T2WI）可呈高信号、中高混杂信号或中信号。75例行外侧开眶术，37例行前路开眶术。随访时间为（64.3±4.1）个月，手术并发症包括视力丧失3例，上睑下垂16例，眼球运动障碍9例。术后复发6例。结论眼眶神经鞘瘤大多表现为良性实体眶内占位病变，眼眶CT检查多表现为沿眼眶前后轴分布的椭圆形或串珠状肿物，少部分肿瘤内有低密度液化区，在眼眶MRI检查中T1WI多为中信号，T2WI多为中高混杂信号，病理组织学检查是其确诊依据，手术完整切除该肿瘤后复发率较低，复发病例可行术后放射治疗控制病情。

ObjectiveTo explore and summarize the clinical manifestation, iconographic characterizations, principles of diagnosis and treatment of orbital neurilemomas.MethodsRetrospective case series study. A total of 112 patients diagnosed with orbital neurilemomas and received surgery at Tianjin Eye Hospital from January 2002 to December 2016 were included. The clinical symptoms, eye signs, imageological examination, diagnosis treatment and prognosis of the patients were analyzed. SPSS 21.0 software was used to describe age and follow-up time.ResultsIn the 112 cases, 48 cases were male, 64 cases were female. At the time of diagnosis, the age of patients ranged from 13 to 73 years. The mean age at diagnosis was （40±4） years. B ultrasound scan was applied in all 112 cases, results revealed round, elliptical, beaded, and irregular shaped lesion in orbit with clear boundary, which was characterized with poor echo, strong sonolucency, and mild compressibility. CT scan was also applied in all 112 cases. The lesions were elliptical, lobulated, S-shaped, or peanut shaped, primarily characterized with evenly high density and a few with the low density fluidized region. MRI was applied in 54 cases. T1 weighted image （T1WI） showed medium signal in all lesions. T2 weighted image （T2WI） showed high, mixed and medium signal. Surgical approaches included lateral orbitotomy in 75 cases, and anterior orbitotmy in 37 cases. Average follow-up time was （64.3±4.1） months. Surgical complications included vison loss （in 3 cases）, postoperation ptosis （in 16 cases）, and disturbance of eyeballs movement （in 9 cases）, while 6 cases involved with recurrence.ConclusionsOrbital schwannoma is mostly characterized with benign solid orbital lesions. Orbital CT examination results of orbital schwannoma are mainly characterized with ellipsoid or beaded mass along the anterior posterior axis of orbit, while a few of tumors showed low density liquefaction areas. T1WI shows medium signal in most lesions, and T2WI shows mixed signal in most lessions. Histopathologic examination is the basis for confirmation of diagnosis. The recurrence rate is lower after the complete resection of the tumor. Postoperative radiotherapy could be used for controlling the recurrence. （Chin J Ophthalmol, 2018, 54： 509-514）