CAJ | 학술논문

背景眼眶海绵状血管瘤(OCH)是成人常见的原发于眼眶的良性肿瘤,术前准确的定性、定位诊断是安全、有效摘除肿瘤的重要前提. 目的探讨OCH的临床特点、术前诊断、不同手术进路的适应证选择、治疗效果及并发症预防.方法对2011年1月至2014年12月在河南省眼科研究所河南省立眼科医院接受手术治疗并经病理学检查确诊的OCH患者117例117眼的临床资料进行回顾性分析.患者分别于术前及术后接受视力、眼球突出度、眼球运动、眼眶扪诊、眼眶A型和B型超声、CDI、CT和MRI检查,并根据肿瘤在眼眶中的位置分别接受前路开眶术、外侧开眶术或外侧联合内侧开眶术.比较手术前后视觉功能和眼眶的形态学改变. 结果 OCH以渐进性眼球突出和视力下降为主要临床表现,117眼术前诊断与术后病理学诊断的符合率为100％.采用结膜入路者占52.14％ (61/117),外侧开眶术者占30.77％ (36/117),前路开眶皮肤切口术者占16.24％ (19/117),外侧结合内侧开眶术者占0.85％ (1/117).随访3个月～5年,影像学检查未见肿瘤残留和复发.术后视力较术前提高者占30.77％ (36/117),下降者占8.55％ (10/117),视力不变者占60.68％ (71/117).术后一过性并发症为瞳孔改变者占14.53％ (17/117),眶内大出血者占1.71％(2/117),眼球运动障碍者占16.24％ (19/117),上睑下垂者占4.27％ (5/117);术后永久性并发症为瞳孔向心性扩大3眼及视力丧失和永久性外展运动受限各1眼. 结论 OCH术前定性和定位诊断主要根据临床和影像学检查,影像学检查结果有助于手术进路的选择,合适的手术方法和熟练的技巧对于OCH的治疗是安全且有效的.
배경 안광해면상혈관류(OCH)시성인상견적원발우안광적량성종류,술전준학적정성、정위진단시안전、유효적제종류적중요전제. 목적 탐토OCH적림상특점、술전진단、불동수술진로적괄응증선택、치료효과급병발증예방.방법 대2011년1월지2014년12월재하남성안과연구소하남성립안과의원접수수술치료병경병이학검사학진적OCH환자117례117안적림상자료진행회고성분석.환자분별우술전급술후접수시력、안구돌출도、안구운동、안광문진、안광A형화B형초성、CDI、CT화MRI검사,병근거종류재안광중적위치분별접수전로개광술、외측개광술혹외측연합내측개광술.비교수술전후시각공능화안광적형태학개변. 결과 OCH이점진성안구돌출화시력하강위주요림상표현,117안술전진단여술후병이학진단적부합솔위100％.채용결막입로자점52.14％ (61/117),외측개광술자점30.77％ (36/117),전로개광피부절구술자점16.24％ (19/117),외측결합내측개광술자점0.85％ (1/117).수방3개월～5년,영상학검사미견종류잔류화복발.술후시력교술전제고자점30.77％ (36/117),하강자점8.55％ (10/117),시력불변자점60.68％ (71/117).술후일과성병발증위동공개변자점14.53％ (17/117),광내대출혈자점1.71％(2/117),안구운동장애자점16.24％ (19/117),상검하수자점4.27％ (5/117);술후영구성병발증위동공향심성확대3안급시력상실화영구성외전운동수한각1안. 결론 OCH술전정성화정위진단주요근거림상화영상학검사,영상학검사결과유조우수술진로적선택,합괄적수술방법화숙련적기교대우OCH적치료시안전차유효적.
Background Orbital cavernous hemangiomas (OCH) is a common benign orbital tumor in adult,and accurate localization and diagnosis before operation supports the significant premise for surgical safety and success of tumor extraction.Objective This study was to research the clinical characteristics,preoperative diagnosis,the selection for different surgical approaches,therapeutic effectiveness and complication prevention of OCH.Methods The clinical data of 117 eyes of 117 patients with OCH who received surgery were retrospectively analyzed.The patients received surgery in Henan Eye Institute,Henan Eye Hospital from January 2011 to December 2014 and followed-up for 3 months to 5 years.The visual acuity,exophthalmos,ocular movement,orbital A/B ultrasound,color Doppler image,CT and MRI were examined before and after surgery.Results The primary clinical manifestations of OCH were gradual exophthalmos and impaired vision.The accordance rate of preoperative diagnosis and pathological diagnosis was 100％ in the group of patients.The surgical approachs included conjunctival approach in 52.14％ (61/117),lateral orbitectomy in 30.77％ (36/117),anterior approach in 16.24％ (19/117) and lateral combined with medial approach in 0.85％ (1/117).At the end of followed-up,visual acuity was significantly improved in 30.77％ (36/117),declined in 8.55％ (10/117) and unchanged in 60.68％ (71/117).Temporary complications after surgery were pupil dilatation in 14.53％ (17/117),emorrhoea in 1.71％ (2/117),ocular motility disorders in 16.24％ (19/117) and ptosis in 4.27％ (5/117).The permanent complications after operation were pupil dilatation in 2.56％ (3/117),visual loss in 0.85％ (1/117) and permanent abduction imitation in 0.85％ (1/117).Conclusions Accurate qualitative and site-specific diagnosis and correct choice of surgeries for OCH depend on clinical and iconographical examinations.Suitable surgical approach and operative skill are helpful to the therapeutic outcome and safety of OCH.