CAJ | 학술논문

目的总结鼻内镜下经筛窦入路摘除眼眶内侧肿瘤的手术适应证、手术技巧及并发症.方法回顾性系列病例研究.收集2014年5月至2015年1月在武警总医院眼眶病研究所手术治疗的12例患者资料,记录术前及随访的患者视力、眼球突出度、眼球运动、上睑运动功能等.最佳矫正视力下降者检查眼底、瞳孔及视野.所有患者术前行眼眶CT及磁共振检查,记录肿瘤的部位和大小.纳入本研究的标准为:影像学符合海绵状血管瘤、神经鞘瘤或皮样囊肿,且冠状位像肿瘤位于视神经鼻侧,轴位像位于眶中后部至眶尖.手术在全身麻醉下利用鼻内镜手术系统,先行筛窦开放术,后在筛骨纸样板开骨窗进入眶内,分离并暴露肿瘤,10例辅助泪阜结膜微切口分离,最后经筛窦摘除肿瘤.结果 12例患者中男性4例,女性8例,年龄14.0～67.0岁,中位数年龄44.5岁.11例肿瘤完整摘除,1例分块切除,均经病理学确诊,其中海绵状血管瘤10例,神经鞘瘤1例,皮样囊肿1例.肿瘤大小从11 mm×11 mm×10mm至24 mm×23 mm×16 mm.3例肿瘤位于肌锥的鼻侧,7例位于肌锥内,1例同时占据肌锥内和外,1例位于内直肌内.8例肿瘤位于眶尖,4例位于眶中后部.随访3～11个月,3例术后最佳矫正视力提高,视野缺损恢复.并发症均发生在肌锥内肿瘤,主要包括2例视力下降,1例视力丧失;暂时性眼球运动受限5例,术后3个月内恢复正常;外转和内转轻度受限不缓解各1例.结论鼻内镜下经筛窦入路适合摘除位于眶中后部和眶尖部的视神经鼻侧海绵状血管瘤,神经鞘瘤或皮样囊肿.肿瘤位于肌锥鼻侧较肌锥内安全性高.辅助泪阜结膜微切口分离和暴露肌锥内肿瘤,有助于减少手术并发症.
목적 총결비내경하경사두입로적제안광내측종류적수술괄응증、수술기교급병발증.방법 회고성계렬병례연구.수집2014년5월지2015년1월재무경총의원안광병연구소수술치료적12례환자자료,기록술전급수방적환자시력、안구돌출도、안구운동、상검운동공능등.최가교정시력하강자검사안저、동공급시야.소유환자술전행안광CT급자공진검사,기록종류적부위화대소.납입본연구적표준위:영상학부합해면상혈관류、신경초류혹피양낭종,차관상위상종류위우시신경비측,축위상위우광중후부지광첨.수술재전신마취하이용비내경수술계통,선행사두개방술,후재사골지양판개골창진입광내,분리병폭로종류,10례보조루부결막미절구분리,최후경사두적제종류.결과 12례환자중남성4례,녀성8례,년령14.0～67.0세,중위수년령44.5세.11례종류완정적제,1례분괴절제,균경병이학학진,기중해면상혈관류10례,신경초류1례,피양낭종1례.종류대소종11 mm×11 mm×10mm지24 mm×23 mm×16 mm.3례종류위우기추적비측,7례위우기추내,1례동시점거기추내화외,1례위우내직기내.8례종류위우광첨,4례위우광중후부.수방3～11개월,3례술후최가교정시력제고,시야결손회복.병발증균발생재기추내종류,주요포괄2례시력하강,1례시력상실;잠시성안구운동수한5례,술후3개월내회복정상;외전화내전경도수한불완해각1례.결론 비내경하경사두입로괄합적제위우광중후부화광첨부적시신경비측해면상혈관류,신경초류혹피양낭종.종류위우기추비측교기추내안전성고.보조루부결막미절구분리화폭로기추내종류,유조우감소수술병발증.
Objective To determine the indications,surgical skills,and complications for removal of intraorbital lesions using an endoscopic transethmoidal approach.Methods A retrospective case series of 12 cases between May 2014 and January 2015 were conducted.Data included visual acuity,exophthalmos,ocular movement,and eyelid function of preoperation and follow-up.The location and size of the lesions were showed and recorded on CT and MRI scans.The cases with imaging diagnosis of cavernous hemangioma,schwannoma or dermoid cyst were included into this study.On the coronal slices the lesions should be located medially to the optic nerve.On the axial slices they should be located in the middle,posterior orbit or apex.The surgical approach began with performance of an endoscopic ethmoidectomy under general anesthesia.A bony window was opened on the lamina papyracea and transethmoidal dissection and removal of an intraorbital lesion was made,with the combination of a mini caruncula incision in 10 cases.Results There were 4 male and 8 female patients,with the median age of 44.5 years (ranging from 14.0 to 67.0 years).En bloc tumor resection in 11 cases or piecemeal resection in 1 case was achieved,including 10 cases of hemangioma,and one each schwannoma and dermoid cyst,confirmed by pathologic examination.The tumor size ranged from 11 mm× 11 mm× 10mm to 24 mm×23 mm× 16 mm.Three tumors were located medially to the muscle cone,7 tumors in the cone.One case was located extra-and intracone simulataneously and 1 in the medial rectus muscle.There are 8 tumors within the apex and 4 in the middle and posterior orbit.After 3-11 months follow-up,the best-corrected visual acuity and visual field improved in 3 cases,decreased in 2 case,and vision loss in 1 case.Transient limited ocular movement in 5 cases was recovered within 3 months after surgery.The irreversible limited ocular lateral or medial movement was recorded in 1 case respectively.All complications were recorded in the cases of tumors in the muscle cone.Conclusions The endoscopic transethmoidal approach is a useful approach for cavernous hemangiomas,schwannoma or dermoid cyst located medially to the optic nerve in the middle or posterior orbit.It's safer for the tumor located medially to the muscle cone than in the cone.It's an important surgical skill to reduce the complications that intraorbital dissection and exposure of tumors in the cone are assisted with a mini caruncula incision.