眼眶肿瘤采用不同手术入路治疗的临床疗效观察

Clinical observation on the outcomes of orbital tumors treated by different surgical modality

目的:观察不同手术入路治疗眼眶肿瘤的临床效果。方法:收集2015年1月~2020年1月在弋矶山医院住院手术的眼眶肿瘤患者77例(79眼),根据肿瘤的位置、大小和性质不同,采用前路开眶、外侧开眶及眶内容物剜除术,观察术中肿瘤的切除是否完整、术后并发症如瞳孔的改变、上睑下垂及眼球运动受限情况、术后随访6个月的复发情况。结果:77例中有7例7眼(9.1%)肿瘤残留,前路开眶术肿瘤残留率(10.3%)高于外侧开眶术、眶内容物剜除术(0.0%、0.0%),但差异无统计学意义(P>0.05)。早期并发症发生率为2.6%,三种手术入路患者术后早期并发症发生率(1.5%、14.3%、0.0%)比较,差异无统计学意义(P>0.05)。随访期内,有1例1眼(1.3%)复发,三种手术入路患者术后复发率(14.3%、0.0%、0.0%)比较,差异无统计学意义(P>0.05)。结论:眼眶肿瘤手术方式的选择需要综合考虑肿瘤的大小、位置及生物学特性,以保证肿瘤完整切除,减少手术损伤,降低术后并发症的发生及肿瘤复发的可能。

Objective:To observe the clinical outcomes of different surgical approach to the treatment of orbital tumors.Methods:Seventy-seven patients(79 eyes)with orbital tumor treated in our department were included from January 2015 to January 2020,and underwent either anterior orbitotomy,lateral orbitotomy or exenteration of the orbit in compliance with the tumor location,size and nature.All patients were observed regarding complete or failed intraoperative tumor excision,postoperative complications,including the change of pupil,ptosis and limited eye movement as well as relapse in 6 months during the postoperative follow-up.Results:Residual tumor was seen in 7(7 eyes)of the 77 patients(9.1%).The rate of residual tumor was higher in patients treated by anterior orbitotomy(10.3%)than in those treated by lateral orbitotomy(0.0%)or exenteration of the orbit(0.0%),yet there was no significant difference(P>0.05).The incidence of early complications was 2.6%overall,and 1.5%,14.3%and 0.0%,respectively for the three surgical modalities,without significant difference(P>0.05).Relapse occurred in one case(one eye,1.3%)during follow-up,and the relapse rate was insignificant for the three surgical approaches(14.3%,0.0%and 0.0%,respectively,P>0.05).Conclusion:Optional orbitotomy in treating orbital tumor can rely on the tumor location,size and its biological property in order to ensure complete removal of the neoplasm,reduce the injury from surgery and postoperative complications as well as potential relapse after surgery.