继发性眶黏液囊肿两种手术进路比较

The comparison of two kinds of surgical approach in secondary orbital mucocele

目的 比较继发性眼眶黏液囊肿两种手术进路 (结膜进路和皮肤进路 )的特点和对眼眶结构的影响 ,以选择最好的手术途径 ,取得最好的手术效果。方法 总结 1991年～ 2 0 0 2年在我院治疗的继发性眼眶粘液囊肿 41例 ,分别就两种进路的手术方法、效果和手术并发症进行对比分析。结果 手术采用结膜进路者 16例 ,皮肤进路者 2 5例。患者术后观察 3个月～ 10年不等 ,眼球均能复位 ,眼球运动恢复正常。 2例经皮肤进路患者中 ,1例术后 1年发现眶内上方隆起 ,经CT检查证实囊肿复发 ;1例术中损伤泪道 ,致术后泪溢。其余患者未见囊肿复发和其他并发症。经结膜进路患者面部无可见瘢痕和其他并发症。结论 皮肤进路距离病变较近 ,操作方便 ,但有时容易损伤滑车和泪道 ,导致术后复视和泪溢 ;面部遗留可见瘢痕。结膜切口可直接进入病变区 ,避开了滑车和泪道等重要结构 ;外观无改变 ,患者容易接受。结膜进路是一种较好的手术途径。

Objective Characters and affects on orbital structures of two kinds of surgical approach in secondary orbital mucocele were compared in order to select the best surgical method and get the best surgical effect.Methods 41 cases of secondary orbital mucocele during 1991～2002 were analysed on surgical methods,effects and complications of two kinds of approach.Results 16 patients were performed by conjunctival approach and 25 patients by skin approach.Patients were followed up from 3 months to 10 years.All patients had no eyeball displayment and eye movement abnormality.Mucocele recurred 1 year later in 1 patient;The lacrimal duct was injured in 1 patient.These two patients were perfromed by skin approach.No complications were observed in the other patients.Patients performed by conjunctival approach had no scar on faces and other complications.Conclusions Skin approach is near to lesions and easily to perform,but sometimes the trochlea and lacrimal duct can be injured and result in diplopia and epiphoria.An obvious scar lefe on the face.Lesions can be exposed directly by conjunctival approach,avoiding injuring some important structures such as trochlea and lacrimal duct,and normal cosmetic can be kept.Therefore,conjunctival approach is a uesful surgical method.