结膜乳头状瘤的诊治体会

Diagnosis and treatment of conjunctival papilloma

目的分析和探讨眼结膜乳头状瘤的临床表现、活体共聚焦显微镜检查图像特征、治疗方法及其疗效。方法回顾性分析2013年1月至2016年12月在南通大学附属医院眼科治疗的共29例(29只眼)经病理证实为结膜乳头状瘤的住院患者的临床资料,其中10例为结膜型乳头状瘤,19例为角膜缘型乳头状瘤。7例完成活体共聚焦显微镜检查,所有患者采用"肿物切除联合冷冻及羊膜遮盖术"治疗。术后随访6个月至4年。结果25例(25只眼)治疗后随访无复发。2例患者术后复发,经治疗随访至2年未见再发。术后2例失访。7例(长入角膜>4 mm或浸润>1/2圈角膜缘)完成活体共聚焦显微镜检查,图像可见角膜上皮细胞非典型增生,均未见有细胞团似"癌巢"样改变。结论肿物切除联合冷冻和羊膜遮盖术是治疗眼结膜乳头状瘤的有效方法。治疗后有复发可能。活体共聚焦显微镜检查可为术前诊断眼角结膜肿物性质提供重要依据。

Objective To evaluate the clinical manifestations,the features of confocal microscopy images,the major treatments and their therapeutic effectiveness of conjunctival papilloma.Methods This study applies retrospective analysis on 29 patients(29 eyes)who pathologically confirmed conjunctival papillomas from January 2013 to December 2016 in Affiliated Hospital of Nantong University,including 10 cases with conjunctival papilloma and the other 19 with limbal papilloma.Seven patients were examined by vivo confocal microscopy,and all patients were treated with"excision combined with freezing and amniotic membrane patching".The follow-up time was from 6 months to 4 years.Results Twenty-five patients(25 eyes)had no recurrence after treatment.Two patients had postoperative recurrences and then no recurrence after retreatment was observed within 2 years of follow-up.Seven cases(grown cornea>4mm or infiltrated>1/2 ring of limbus)were examined by vivo confocal microscopy.The images showed atypical hyperplasia of corneal epithelial cells without any cell clusters similar to"cancer nests".Two patients lost follow-up after surgery.Conclusions Excision combined with freezing and amniotic membrane patching is an effective method for the treatment of conjunctival papilloma.There may be recurrence after treatment.Vivo confocal microscopy examination provides an important basis for preoperative diagnosis of conjunctival masses.