CAJ | 학술논문

目的探讨经骨膜下入路摘除眼眶海绵状血管瘤的适应证及手术效果.方法回顾性系列病例研究.对2004年6月至2010年6月在武警总医院眼眶病研究所手术并经病理学确诊的眼眶海绵状血管瘤(OCH)患者资料42例行回顾性分析.术前根据临床表现、CT及MRI影像学特征诊断为OCH.根据肿瘤发生部位分为4组:Ⅰ组(18例),肿瘤位于眼眶颞上象限；Ⅱ组(15例),肿瘤位于眶上裂及周围的眶尖部；Ⅲ组(4例),肿瘤位于眶底部的周围间隙,深至眶尖；Ⅳ组(5例),肿瘤位于鼻下象限.4组均采用眶周皮肤切口,分离至眶缘骨膜后,经骨膜下入路摘除OCH.记录术后并发症和随访结果.结果术前诊断正确率100％.所有肿瘤均经一次手术彻底摘除,手术时间平均20 ～ 30 min.38例(90.5％)完整摘除,4例(9.5％)分块取出.为扩大Ⅱ组眶尖部术野,6例(14.3％)截除眶外上方骨缘,3例(7.1％)使用磨钻磨除眶壁骨质.随访1～7年,影像学证实无肿瘤残留或复发,6例(14.3％)视力较术前提高.术后暂时性并发症包括:球结膜水肿9例(21.4％),眼球运动受限4例(9.5％)和3例上睑下垂(7.1％).永久性并发症包括:眼球极限运动受限和瞳孔向心性扩大,各2例(4.7％).结论经骨膜下入路适合摘除眼眶颞上、鼻下及眶底部等距骨壁较近且粘连不重的OCH,或眶上裂附近的OCH,手术安全有效,无严重并发症.
목적 탐토경골막하입로적제안광해면상혈관류적괄응증급수술효과.방법 회고성계렬병례연구.대2004년6월지2010년6월재무경총의원안광병연구소수술병경병이학학진적안광해면상혈관류(OCH)환자자료42례행회고성분석.술전근거림상표현、CT급MRI영상학특정진단위OCH.근거종류발생부위분위4조:Ⅰ조(18례),종류위우안광섭상상한；Ⅱ조(15례),종류위우광상렬급주위적광첨부；Ⅲ조(4례),종류위우광저부적주위간극,심지광첨；Ⅳ조(5례),종류위우비하상한.4조균채용광주피부절구,분리지광연골막후,경골막하입로적제OCH.기록술후병발증화수방결과.결과 술전진단정학솔100％.소유종류균경일차수술철저적제,수술시간평균20 ～ 30 min.38례(90.5％)완정적제,4례(9.5％)분괴취출.위확대Ⅱ조광첨부술야,6례(14.3％)절제광외상방골연,3례(7.1％)사용마찬마제광벽골질.수방1～7년,영상학증실무종류잔류혹복발,6례(14.3％)시력교술전제고.술후잠시성병발증포괄:구결막수종9례(21.4％),안구운동수한4례(9.5％)화3례상검하수(7.1％).영구성병발증포괄:안구겁한운동수한화동공향심성확대,각2례(4.7％).결론 경골막하입로괄합적제안광섭상、비하급광저부등거골벽교근차점련불중적OCH,혹광상렬부근적OCH,수술안전유효,무엄중병발증.
Objective To evaluate the indications,operative skills and effects of transsubperiosteal approach for excision of orbital cavernous hemangiomas (OCH).Methods In a retrospective study,the records of 42 cases with OCH confirmed by pathologic examination between June 2004 and June 2010 were analyzed.Preoperative diagnoses were based on clinical signs,CT and MRI examinations.According to the locations of the tumor,patients were assigned to 4 groups:group Ⅰ:tumors located in the superotemporal quadrant in 18 cases; group Ⅱ:tumors located in or near the superior orbital fissure in 15 cases; group Ⅲ:tumors in the inferior peripheral space extending to the orbital apex in 4 cases; group Ⅳ:tumors in the inferonasal quadrant in 5 cases.In all 4 groups the periorbital skin was incised and then the periosteum of orbital rim was exposed.Tumors were removed from subperiosteal space.The complications and follow-up results were recorded.Results The rate of preoperative correct diagnosis was 100％.All cases were cured by once surgical procedures for average 20-30 min.Thirty-eight (90.5％) tumors were removed intact.The deblocking removal was recorded in 4 (9.5％) cases.In order to improve the surgical exposure of orbital apex in group Ⅱ,superolateral orbital rim was removed in 6 (14.3％) cases and the walls were drilled in 3 (7.1％) cases.Follow-up periods ranged 1 to 7 years.No recurrent or remnant was recorded on imaging reviews.The visual acuity was improved in 6 (14.3％) cases.The temporary complications included chemosis in 9 (21.4％) cases,limited ocular movement in 4 (9.5％) cases and ptosis in 3 (7.1％) cases.The permanent complications included limited ocular extreme movement and dilated pupil,both in 2 cases (4.7％).Conclusions Transsubperiosteal approach is eligible for the removal of OCH in the superotemporal,inferonasal quadrant and the floor of the orbit and is recommended for the tumors near the superior orbital fissure.This approach is safe and effective for removal of OCH with less surgical complication.