眼表肿物50例临床分析

Clinical analysis of 50 cases of ocular surface tumor

目的分析眼表肿物的临床特征、性质及其治疗方法。方法对连续2年经我院治疗的50例(53只眼)眼表肿物进行分析。记录肿物临床体征。根据形态、大小、位置确定手术方法,手术方法根据肿物大小及位置分为4种:①单纯肿物切除,②肿物切除联合冷冻术,③肿物切除联合冷冻术联合羊膜移植术,④肿物切除联合部分板层角膜移植术。肿物切除常规病理检查确定性质、分析病理结果,术后观察发随访复发情况。结果角结膜鳞状细胞癌形态呈菜花状且见松针样毛细血管扩张。角膜原位癌呈半透明或胶冻状白色,表面凹凸不平。色素痣扁平、黑色弥漫浸润,界限较清楚。结膜乳头状瘤呈桑葚或乳头状隆于表面。单纯肿物切除21例,肿物切除联合冷冻术17例,肿物切除联合冷冻术联合羊膜移植术10例,肿物切除联合部分板层角膜移植术2例。根据病理结果,恶性肿物共23例(46%),良性肿物27例(54%)。恶性肿瘤可见异型性明显,角结膜鳞状细胞癌鳞状上皮增生活跃,呈浸润性生长,突破基底膜。角膜原位癌、角结膜上皮内瘤变基底膜完整。良性肿物结膜乳头状瘤呈乳头状,可见纤维血管轴心。色素痣见痣细胞呈巢团状分布。随访时间1～10年(平均4. 8年),恶性肿物随访19例,其中4例复发。良性肿物随访20例,20例中均未复发。共失访11例,4例为恶性眼表肿物患者,7例为良性。结论眼表肿物中恶性发病比例较高,发现眼表肿物应尽早切除,并行病理检查明确肿物性质。

Objective To investigate the clinical features,properties and treatment of ocular surface tumors.Methods 50 cases of ocular surface tumors(53 eyes)treated in our hospital for 2 consecutive years were analyzed.The clinical features of the tumors were recorded.Surgical treatment was determined according to the size and position of the tumor,and can be divided into four types:simple tumor resection(21 cases),tumor resection combined with cryopreservation(17 cases),tumor resection combined with cryopreservation and amniotic membrane transplantation(10 cases),tumor resection combined with partial lamellar keratoplasty(2 cases).The resected tumor was sent for routine pathological examination and the recurrence was observed post-operatively.Results The keratoconjunctival squamous cell carcinoma showed the shape of cauliflower and pine needle capillary dilatation.The corneal carcinoma in situ was translucent or gelatinous white with irregular surface.The pigmented nevus was flat with black diffuse infiltration,and a clear boundary.The conjunctival papilloma was mulberry or with papillary protuberance on the surface.There were a total of 23 malignant tumor cases(46% )and 27 benign tumor cases(54% ).Malignant tumors demonstrated obvious heterogeneity.In cases of conjunctival squamous cell carcinoma,the squamous epithelial hyperplasia was active with invasive growth which breaked the basement membrane.The basement membrane in corneal carcinoma in situ and keratoconjunctival intraepithelial neoplasia was intact.Benign tumors of conjunctival papilloma were papillary and fibrous vessel axis could be seen.Nevus cells in pigmented nevus showed nested distribution.The patients were followed up for 1 to 10 years(average:4.8 years).19 malignant tumors were followed up,of which 4 cases recurred.No recurrence was found in the 20 follow-up patients with benign tumors.A total of 11 cases were lost to follow-up,in which 4 were malignant ocular surface tumors,and 7 cases were benign.Conclusions The proportion of malignant tumors is high in ocular surface tumors.It should be recommended that ocular surface tumors be removed as soon as possible,and pathological examination should be used to determine the nature of the tumors.