鼻腔鼻窦恶性肿瘤伴眶侵犯的眼眶处理策略

Treatment Strategies of Orbit in Sinonasal Malignancy Patients with Orbital Invasion

鼻腔鼻窦和眼眶相邻,鼻腔鼻窦恶性肿瘤容易侵犯眼眶,这既是肿瘤晚期表现又是其不良预后因素之一。肿瘤眶侵犯,术前采用CT和MRI进行评估,术中借助冰冻切片进行判断。肿瘤未侵犯眶骨膜,保留眶内容物;肿瘤累及眶骨膜和肌锥外脂肪范围有限或切缘阴性,对新辅助化疗、放疗等多模式治疗方案反应良好,可以考虑保留眶内容物;肿瘤广泛侵犯眶骨膜,侵犯眼球、眼外肌、眶尖者需切除眶内容物。眶内容物无论是保留还是切除,都应该由多学科团队共同进行评估、决策,并与患者进行充分沟通。

Due to the paranasal sinuses adjacent to the orbit,the sinonasal malignancy is prone to invade the orbit,which is not only the advanced stage of the tumor,but also one of the poor prognostic factors.Preoperative CT and MRI scan and intraoperative frozen section analysis are used to evaluate the orbital invasion of the tumor.Orbital preservation is adopted if the periorbita is not transgressed by tumor.Orbital preservation can be considered if the tumor invades the periorbita and extraconal fat in a limited range,responds well to neoadjuvant chemotherapy,radiotherapy or other multimodality treatment,or has a negative section margin.Orbital exenteration is performed if the tumor extensively invades the periorbita,and invades the extraocular muscle,eyeball and orbital apex.Whether orbital preservation or orbital exenteration is adopted,it should be evaluated and made decision by a multidisciplinary team,and fully communicate with the patient.