针对性手术入路对眼眶深部海绵状血管瘤近中期预后的影响

The effect of targeted surgical approaches on the short-and medium-term prognosis of deep orbital cavernous hemangioma

目的探讨针对性手术入路治疗眼眶深部海绵状血管瘤对近中期预后的影响。方法回顾性分析2013年5月—2018年9月在青岛市中医医院接受手术治疗的120例眼眶深部海绵状血管瘤患者病例资料。根据手术入路的不同分为结膜入路组(33例,经结膜入路前路开眶术)、皮肤入路组(30例,经皮肤入路前路开眶术)、外侧入路组(31例,外侧开眶术)、内外联合组(26例,内侧联合外侧入路开眶术)。比较各组视力及眼球突出度变化、血清炎症因子、并发症、近中期预后。结果各组视力及眼球突出度比较,差异无统计学意义(P>0.05)。各组术前炎症因子比较,差异无统计学意义(P>0.05),各组术后炎症因子比较,差异有统计学意义(P<0.05)。各组并发症总发生率比较,差异无统计学意义(P>0.05)。各组术后残留率及术后1年、3年复发率比较,差异无统计学意义(P>0.05)。结论4种手术入路方式治疗眼眶深部海绵状血管瘤具有相似的疗效和近中期预后,应根据肿瘤具体位置、发展情况、周围解剖结构等选取最合理的入路方式。

Objective To investigate the effect of targeted surgical approaches on the short-and mediumterm prognosis of deep orbital cavernous hemangioma.Methods The data of 120 patients with deep orbital cavernous hemangioma who underwent surgery in our hospital from May 2013 to September 2018 were retrospectively analyzed.According to the surgical approaches,they were divided into transconjunctival approach group(33 cases,anterior orbitotomy),transcutaneous approach group(30 cases,anterior orbitotomy),lateral approach group(31 cases,lateral orbitotomy),and combined medial and lateral approach group(26 cases,medial transconjunctival approach combined with lateral orbitotomy).Visual acuity,exophthalmos,serum inflammatory factors,complications and short-and medium-term prognosis were compared among the four groups.Results There was no significant difference in visual acuity,exophthalmos,the overall incidence of postoperative complications,and the residual rate and recurrence rate at 1 year and 3 years after operation among the four groups(P>0.05).The serum levels of IL-6,IL-8,TNF-α,and CRP were not different among the four groups before the treatment(P>0.05),but were different among the groups after the treatment(P<0.05).Conclusions The four surgical approaches for the treatment of deep orbital cavernous hemangioma exhibit similar efficacy and short-and medium-term prognosis.The optimal approach should be selected according to the specific location and the progression of the tumor,as well as the adjacent anatomical structures.