睫状体肿瘤的临床与病理分析

Clinical and pathogenic study of ciliary tumor

目的 :探讨睫状体肿瘤的临床特点、组织病理特征、超声生物显微镜 (UBM)诊断价值以及局部切除玻璃体视网膜联合手术的疗效、安全性及适应证范围。方法 :2 2例经UBM、B型超声等检查诊断为睫状体肿瘤的患者 ,肿瘤最大径 4～1 6mm ,晶状体限局性混浊或限局性赤道部凹痕 6例 ,完全混浊 3例 ,4例合并视网膜脱离。采用全身低血压麻醉 ,行局部板层巩膜睫状体或局部板层巩膜睫状体前脉络膜切除联合玻璃体视网膜手术和异体巩膜移植术 ,切除的肿瘤行病理检查。结果 :术后经 2个月～ 5年 3个月 (平均 2 8个月 )随访 ,未发现肿瘤复发 ,1例睫状体恶性黑色素瘤 (上皮细胞型 )直径超过 1 5mm ,术后 2年发生肝转移。末次随访时 ,视力 0 0 5～ 0 3者 7例 ,>0 3者 1 5例。病理诊断 :睫状体恶性黑色素瘤 9例 ,黑色素细胞瘤 4例 ,无色素上皮腺瘤 6例 ,神经纤维瘤 2例 ,神经鞘瘤 1例。结论 :睫状体肿瘤中良性肿瘤约占一半 (1 3/ 2 2 ) ,UBM对睫状体肿瘤的早期诊断有帮助 ,是确定病变大小、部位及与周围组织关系的重要工具。睫状体肿瘤局部切除不仅可以保留患眼 ,挽救视力 ,而且对切除组织病理检查可明确诊断。联合玻璃体视网膜手术可减少并发症 ,提高成功率 ,是治疗某些睫状体良。

Objective:To investigate the clinical features,histopathogenesis and the value of ultrasound biomicroscopy(UBM)in the diagnosis of ciliary tumor,as well as the efficacy safety and indications of ciliary tumor for local resection with vitreoretinal surgery.Methods:22cases of ciliary tumors with the maximal diameter of 4 16 mm,diagnosed with UBM and B scan were studied.In 6 cases,there were partial opacity of lens or local incurvation of lens equator,complete opacity of lens in 3 cases and retinal detachment in 4 cases.Under hypotensive general anesthesia,all cases were underwent vitreoretinal surgery local lamellar,sclerociliary and sclerociliary anterior choriod resection and scleral allograft was implanted if necessary.The resected tumor was examined pathologically.Results:At 2 to 63 months(average 28 months) postoperative follow up period,there were no recurrences,but 1 case of malignant melanoma(epithelioid type)with diameter larger than 15 mm developed hepatic metastasis 21/2 years postoperatively.At the last follow up period,the visual acuties in 7 cases remained 0 05 0 3;and >0 3 in 15 cases.The pathologic diagnosis in these cases included ciliary malignant melanoma in 9 cases;melanocyestoma in 4 cases;nonpigmented epithelioadenoma in 6 cases;neurofibroma in 2 cases;and neurilemoma in 1 case.Conclusions:Half of the ciliary tumors(13/22) are benign.UBM examination is the important method in early diagnosis of the size and the location of ciliary tumor and analyse the relationship between the ciliary tumor and the related tissues.Local lamellar sclerociliary resection with vitreoretinal surgery is the safe and efficiency method for some benign or malignant tumor of ciliary body.