影像学定位选择眼眶神经鞘瘤不同手术入路的临床研究

Clinical study on different approaches selection for orbital neurilemmomas through image localization

目的评价通过影像学定位选择手术入路切除眼眶神经鞘瘤的效果。方法回顾性病例系列研究。收集天津医科大学第二医院2000年至2019年眼眶神经鞘瘤摘除手术93例的临床资料,患者均通过影像学定位选择手术入路。年龄8~82(36.61±15.94)岁,男性37例,女性54例。分别采用前路开眶、外侧开眶、内外联合开眶以及内侧开眶切除肿瘤。分析肿瘤影像定位与术式选择的关系、肿瘤切除情况及手术后1周的视力。结果前路开眶术45例(包括结膜入路24例,皮肤入路21例),其中2例肿瘤大部分切除;术后1周视力提高2例,不变29例,下降14例,其中1例意外视力丧失。外侧开眶术43例,其中37例病变完全切除,6例病变大部分切除;术后1周视力提高1例,视力不变23,视力下降19例,其中2例意外视力丧失。行内外联合开眶术4例,均完全切除肿瘤;术后1周视力不变1例,视力下降3例,其中1例意外视力丧失。行内侧开眶1例,完整切除肿瘤,术后1周视力无变化。结论在个性化治疗理念指导下,通过影像学肿瘤定位,选择合适术式可成功摘除眼眶神经鞘瘤,并最大限度保存患者视功能。

Objective To evaluate the efficacy of different approaches for orbital neurilemmomas through imaging localization.Methods This was a retrospective case series study.The clinical data of 93 cases with surgical removal of orbital neurilemmomas were collected from 2000 to 2019 in the Second Hospital of Tianjin Medical University.The surgical approach was selected by imaging localization.The ages were from 8 to 82 years with an average of(36.61±15.94)years.There were 37 males and 54 females.The surgical methods of the anterior orbitotomy,lateral orbitotomy,combined lateral and medial orbitotomy,and medial orbitotomy were given to different cases.The relationship between tumor image localization and operation selection was analyzed,together with tumor resection condition and visual acuity at 1 week after operation.Results Forty-five cases were conducted by anterior orbitotomy,including 24 cases with conjunctival approach and 21 cases with percutaneous anterior orbitotomy.The tumors were partially resected in 2 cases.The visual acuity at 1 week after operation improved in 2 cases,remained unchanged in 29 cases,and decreased in 14 cases,including 1 case of accidental vision loss.Lateral orbitotomy was performed in 43 cases,including 37 cases with complete resection and 6 cases with partial resection.The visual acuity at 1 week after operation improved in 1 case,stayed stable in 23 cases,and decreased in 19 cases including 2 cases of accidental vision loss.Combined lateral and medial orbitotomy was performed in 4 cases with complete resection.There was no change of visual acuity at 1 week after operation in 1 case,and visual acuity decreased in 3 cases postoperatively including 1 case of accidental vision loss.One case was performed with medial orbitotomy,and the tumor was completely resected without visual acuity change.Conclusion With the guidance of customization concept,the choice of appropriate surgical approach through imaging localization can successfully remove orbital neurilemmomas and reserve the visual function for patients at the greatest extend.