易混淆的眶尖部肿瘤的MRI特点

分析眶尖部海绵状血管瘤、海绵状淋巴管瘤及神经鞘瘤的ＭＲＩ特点,为临床诊治提供根据。方法对经ＭＲＩ检查,手术及组织病理学证实的１６例眶尖部肿瘤进行分析。结果３种眶尖部肿瘤的ＭＲＩ的增强扫描完全强化时间不同。其中５例海绵状血管瘤所用的时间平均产为１２ｍｉｎ３１ｓ;６例海绵状淋巴管瘤所用的时间平均为７ｍｉｎ７ｓ;５例神经鞘瘤所用的平均时间为３ｍｉｎ２７ｓ,差异有非常显著性,ＭＲＩ增强扫描完全强化所用的时     

眼眶神经鞘瘤30例分析

目的总结分析１９８５～１９９４年在我院经病理证实的孤立性眼眶神经鞘瘤。方法回顾性研究３０例孤立性眼眶神经鞘瘤的临床特点、诊断要点及治疗方法。对不同手术方法的术后并发症及术后复发情况进行了对比。结果孤立性眼眶神经鞘瘤多见于２０～４０岁青壮年，男女患病率差异无显著性。多表现为眼球突出，可伴有视力下降、眼部疼痛、眼球活动受限等。均行手术摘除肿瘤。术后视力下降８例（２６．７％），不变１３例（４３．３％），提高９例（３０．０％）；早期上睑下垂８例（２６．７％），眼球活动受限１１例（３６．７％）。术后随访１．５～１０．０年，５例复发，其中１例为低度恶性，４例为良性。大部分上睑下垂及眼球运动受限者，术后３～６个月恢复正常。结论应根据肿瘤的发生部位，选择最佳手术进路。     

眶尖部肿瘤的诊断与治疗

本文回顾性分析了我院诊治的眶尖部肿瘤２９例。病理检查为海绵状血管瘤１０例，神经鞘瘤８例（其中复发性神经鞘瘤３例），视神经鞘脑膜瘤７例，继发肿瘤及转移瘤３例。眶尖肿瘤主要表现早期视力障碍，轻度眼球突出，眼底视盘水肿或萎缩，早期易误诊。ＣＴ及ＭＲＩ显示眶尖部肿瘤，手术难度较大，合并症多。本文讨论了几种常见眶尖肿瘤的临床诊断特点、手术治疗原则及注意事项     

原发性眼眶肿瘤120例临床病理分析

目的:探讨原发性眼眶肿瘤的发病情况及组织学来源,为原发性眼眶肿瘤的诊断提供参考.方法:回顾性分析我院近5a来原发性眼眶肿瘤患者的病历资料,记录患者的性别、年龄、眼别、病理结果.结果:原发性眼眶肿瘤共120例,血管源性肿瘤32例(26.7%),泪腺源性肿瘤28例(23.3%),眼眶囊肿22例(18.3%),神经源性肿瘤19例(15.8%),淋巴瘤6例(5.0%),炎性假瘤5例(4.1%),肌源性肿瘤3例(2.5%),骨源性肿瘤2例(1.7%),其它未明确诊断的3例(2.5%).其中良性肿瘤93例(77.5%),依次为海绵状血管瘤、皮样囊肿、多形性腺瘤、毛细血管瘤、神经鞘瘤、脑膜瘤、炎性假瘤、表皮样囊肿、视神经胶质瘤、骨瘤、血管平滑肌瘤、淋巴管瘤、皮脂腺瘤、血囊肿、泪腺囊肿.恶性肿瘤24例(20.0%),依次为泪腺腺样囊性癌、淋巴瘤、多形性腺癌、横纹肌肉瘤、泪腺腺癌、恶性黑色素瘤.结论:眼眶肿瘤种类繁多,海绵状血管瘤和泪腺腺样囊性癌仍是最常见的良性和恶性原发性眼眶肿瘤.     

105例眼眶肿瘤临床分析

本文报道１９８１－１９９２年经手术及病理证实的眼眶肿瘤１０５例，其中良性肿瘤８７例，恶性肿瘤１８例。原发于眶内的良性肿瘤除眶假瘤外，居前５位的是海绵状血管瘤、脑膜瘤、皮样囊肿、泪腺混合瘤、神经鞘瘤。发病年龄及病程长短与肿瘤性质有一定关系。文中描述了６７例肿瘤ＣＴ的影像特征，并重点讨论了ＣＴ检查对眼眶肿瘤的诊断价值及限度。     

眼眶内神经鞘瘤的临床病理分析

本文报告了眼眶内神经鞘瘤１６例，均经手术切除及病理检查证实，其中男性６例，女性１０例。发病年龄４—７０岁，平均４０岁。病程１月—５年。右眼１０例，左眼６例。视力０．１—０．５者４例；＞０．５者８例，＜０．１者４例。突眼者１２例，两眼突出度差值最大２３ｍｍ，最小２．５ｍｍ。病理组织学检查：ＡｎｔｏｎｉＡ型８例，ＡｎｔｏｎｉＢ型４例，混合型４例。本文还对眶神经鞘瘤的临床表现、病理特征以及鉴别诊断作了简要的讨论。     

眼眶肿瘤的影像学诊断分析

目的：探讨眼眶肿瘤的影像学诊断特点。方法：对我院经手术病理证实的资料完整的眼眶肿瘤37例，其中血管瘤10例，皮样囊肿8例，炎性假瘤5例，脉络膜恶性黑色素瘤4例，腺混合瘤4例，神经鞘瘤3例，横纹肌肉瘤2例，非何杰金氏淋巴瘤1例进行B超、CT影像学分析。结果：发现这些肿瘤具有特征性的影像学表现，如海绵状血管瘤特征性的强回声可压缩性；神经鞘瘤的低回声、不可压缩性。CT扫描可显著病变形态、大小、位置、进行准确的空间定位，同时也可显示周围结构的继发改变。结论：对大于多数眼眶内肿瘤，B超联合CT检查既快捷又简单，影像学技术在眼眶肿瘤诊断中具有重要价值。     

皮质类固醇治疗婴幼儿眼附属器血管瘤的临床研究

采用口服法和局部注射法对比研究皮质类固醇治疗３５例婴幼儿眼附属器血管瘤。其中毛细血管瘤２８例、海绵状血管瘤７例；眼睑血管瘤２１例、眼眶血管瘤４例、眼睑合并眶前部血管瘤１０例。总的治疗效果，显效２９例（８２．８％）、好转４例（１１．４％）、无效２例（５．７％）、总有效率９４．３％。同时发现，局注法和口服法的显效率无明显差异（Ｐ＞０．０５），但局注法的治愈率明显高于口服法（Ｐ＜０．０５）；年龄小于一岁患儿的显效率明显高于年龄大于一岁的患儿（Ｐ＜０．０５）；治疗后患眼的散光度数比治疗前明显减少（Ｐ＜０．０１）。     

超声显象在眼眶肿瘤诊断中的运用

眼眶肿瘤多位于眼眶深部,部位隐蔽,种类繁多,在临床诊断上较为困难。我院眼科、B 超室自1984年12月至1987年2月,应用B 型超声显象确诊眶内肿病17例,现报告如下。临床资料本组17例,年龄最小者3岁,最大者68岁,平均年龄30.1岁。男性占10例,其余为女性。17例中海绵状血管瘤6例,炎性假瘤3例,眶内皮样囊肿2例,此外动静脉混合瘤、毛细血管瘤、神经鞘瘤、脂肪瘤、恶性淋巴瘤、转移癌各1例。诊断方法:采用Aloka SSD—250型B型超声波诊断仪,换能器频率为5兆赫,灵敏度60分贝。探测深度0～7cm,并照像记     

激光治疗外眼部血管瘤

眼睑、结膜血管瘤是一种因先天性血管畸形而形成的良性肿瘤。临床上多以手术、放疗、冷冻及注射硬化剂等方法治疗，我科于１９７７～１９９６年用二氧化碳激光和Ｎｄ∶ＹＡＧ激光治疗外眼部血管瘤２８６例，治疗效果满意，现报告如下。资料与方法　２８６例中，男１６４例，女１２２例；年龄＜３岁１２８例，３～１６岁６５例，＞１６岁９３例。瘤体约为２５～３０ｃｍ。上睑肿瘤１２７例，下睑肿瘤１３２例，泪阜肿瘤１８例，结膜肿瘤９例。毛细血管型２０５例，海绵状型４６例，混合型３５例。其中２７例曾分别接受硬化剂注射及冷冻治…     

标准化A超联合B超诊断脉络膜血管瘤和脉络膜黑色素瘤

目的：探讨标准化A超和B超联合诊断脉络膜血管瘤和脉络膜黑色素瘤的价值。方法：使用标准化A超联合B超诊断5例脉络膜血管瘤和4例脉络膜黑色素瘤。结果：脉络膜血管瘤标准化A超表现为病变内反射波较高，结构规则，声衰减不明显，B超示眼后极部孤立性占位病变，内回声强而均匀。脉络膜黑色素瘤标准化A超表现为病变内反射较低，声衰减明显，B起示眼内半圆形或蘑菇形实性隆起，可见脉络膜凹陷现象。结论：标准化A超对脉络膜血管瘤和脉络膜黑色素瘤可提供如病变内部结构、内反射、声衰减等诊断信息，B超对病变的形状、定位更有价值。标准化A超鉴别肿瘤的性质要优于B超，并具有可重复性和可比较性的优点。标准化A超联合B超可对脉络膜血管瘤和脉络膜黑色素瘤的诊断起到较好效果。     

眼眶血管性肿瘤和畸形的超声及CT诊断

目的 探讨眼眶血管性肿瘤和畸形的超声(标准化A／B超)及CT检查诊断价值。方法 收集108例眼眶血管性病变患者的临床资料和超声(98例)及CT扫描(108例)图像进行回顾性分析,其中94例经手术及病理证实。海绵状血管瘤54例,静脉曲张26例,静脉性血管瘤13例,婴儿型血管瘤5例,淋巴管瘤6例,其他肿瘤4例。结果 超声检查肿瘤显示率达98％(96／98),假阴性率2％(2／98),术前定性确诊率为93％(91／98)。CT扫描的肿瘤显示率达100％(108／108),术前定性确诊率为92％(99／108)。结论 眼眶血管性肿瘤和畸形的超声检查与CT扫描联合应用对判断病变的性质、范围、位置及手术入路的选择至关重要。（中华眼科杂志,2004,40：364-367)     

眼眶海绵状血管瘤的手术入路选择

目的 探讨眼眶海绵状血管瘤经不同入路手术摘除的效果及其与影像学定位的关系.方法 回顾性病例研究.分析164例经手术摘除的眼眶海绵状血管瘤患者资料,并对这些患者的手术入路、影像学特征、手术效果及其选择标准进行总结.结果 经结膜入路者101例(占61.6％),位于肌锥内间隙,边界清楚且无明显黏连.经皮肤入路前路开眶者25例(占15.2％),位于肌锥外间隙,位置浅在.外侧开眶者32例(占19.5％),位于肌锥内间隙,均有较多黏连.内外侧联合开眶者5例(占3.0％),位于肌锥内间隙,形态不规则或者有较多黏连.内侧开眶者1例(占0.6％)、位于内直肌内侧.156例患者肿瘤完整摘除,仅有2例视力丧失.另8例患者患者大部分切除.结论 眼眶海绵状血管瘤可以通过选择合适的手术入路成功摘除.眼眶手术入路选择应根据病变性质、位置、范围而定,尽可能采取术野暴露清楚,损伤小、易于切除病变和外观良好的手术入路.     

彩色多普勒超声在眼眶病诊断中的价值

目的 探讨彩色超声多普勒（color Doppler imaging,CDI）在眼眶病诊断及鉴别诊断中的应用价值。方法 应用CDI技术对288例眼眶病患者眼眶病病变内部的彩色血流显像和脉冲多普勒频谱进行检测。结果 288例眼眶病中,恶性肿瘤38例,炎性假瘤23例,泪腺混合瘤（血流信号不丰富）18例,神经鞘瘤22例,脑膜瘤7例,良性血管内皮瘤及血管外皮瘤各2例,视神经胶质瘤及神经纤维瘤各1例,瘤体内CDI均可检测出血流信号;海绵状血管瘤62便,皮样囊肿16例及脂肪瘤1例瘤体内CDI检测均无血流信号;静脉性血管瘤29例中,CDI检测出静脉血流信号16例;动静脉血管瘤3例CDI检测出动脉血流信号;静脉曲张15例在颈静脉加压和压力解除过程中示动态血流变化;婴儿性血管瘤6例应用糖皮质激素治疗后内部血流信号明显减少;颈动脉海绵窦瘘13例,其中颈内动脉海绵窦瘘（internal carotid cavernous sinus fistula,CCF)8例和硬脑膜海绵窦瘘（dural cavernous sinus fistula,DCF）5例CDI检测均显示眼上静脉扩张动脉化,同时CCF的眼上静脉的血流速度和每分血流量高于DCF,而阻力指数低于DCF。1例眼上静脉血栓性静脉炎显示眼上静脉扩张但无血流信号。结论 CDI对于多血管性肿瘤和眼眶血管性疾病有其特征性的表现。CDI检测在协助B超、CT或MRI检查眼眶病确定疾病的诊断和鉴别诊断中的重要意义。     

应用99mTc标记红细胞放射核素显像诊断眼眶海绵状血管瘤

目的 评价99mTc-RBC放射核素显像做为一种新的诊断工具,根据肿瘤核素显像情况,对眼眶海绵状血管瘤进行诊断和鉴别诊断.方法 经B型超声、CT或MRI证实为眼眶肿瘤的患者68例进行99mTc-RBC放射核素显像,其中男30例,女38例,平均年龄37.8岁.如果血池相开始出现放射性异常浓集影,且随时间推移,1h后放射性浓集影逐渐增强,至4h时晚期延迟相放射核素明显增强者可判断为海绵状血管瘤.所有患者均行手术或活检后经病理组织学诊断.结果 24例海绵状血管瘤显像为血池相开始出现放射性异常浓集影,且随时间推移,1h后放射性浓集影逐渐增强,至4h时晚期延迟相放射核素明显增强;1例海绵状血管瘤各个时相均未见异常放射性浓集影.43例其他类型肿瘤显像方式与海绵状血管瘤有显著不同.结论 99mTc-RBC显像可作为诊断和鉴别诊断眼眶海绵状血管瘤的一种新方法,可提供术前组织学诊断,从而选择合适的手术入路.     

Orbital Tissue Differentiation with Standardized Echography

The standardized A-scan (Kretztechnik 7200 MA) supplemented by contact B-scan and Doppler ultrasound is a time-tested, highly reliable, and noninvasive tool for the evaluation of patients presenting with signs or symptoms suggesting an orbital lesion. Diseases of the orbital adipose tissue, extraocular muscles, optic nerves and periorbital sinuses are detectable within minutes by the experienced examiner. More than 60 types of orbital lesions can then be differentiated, localized, measured, and schematized.¹ While the value of orbital CT scanning has been widely accepted, standardized echography is now also being recognized as an important modality in the diagnosis and management of orbital and periorbital disease. The use of standardized echography results in more frequent and more accurate tissue differentiation, specifically: (1) standardized tumor patterns closely correlate with histologic diagnoses, (2) vascular flow detection and compression testing (hard or soft), (3) detection and diagnosis of optic nerve sheath distention due to increased subarachnoid fluid (eg, benign intracranial hypertension), and (4) greater sensitivity in detecting mild extraocular muscle thickening (eg, Graves' disease). Additional advantages are the noninvasive nature of the procedure (no radiation) and portability of the equipment.     

A-scan ultrasonography in the diagnosis of orbital dermoid cysts

Eleven patients with anterior and deep orbital masses had A-scan ultrasonography. The ultrasonograms were all similar and demonstrated a dermoid-like pattern of low internal reflectivity and a high-rising, double-peaked posterior surface spike. Although the postoperative pathologic findings in seven cases confirmed the clinical diagnosis of dermoid cyst, other lesions, such as epidermoid cyst, sebaceous cyst, Graves's myopathy, and Ewing's sarcoma were found to show a similar ultrasonographic pattern. This stresses the importance of computed tomography in the diagnosis of orbital tumors.     

Surgical excision of selected amblyogenic periorbital capillary hemangiomas

To report the successful surgical excision of well-circumscribed capillary hemangiomas of the eyelid and orbit inducing occlusion amblyopia in 2 cases with immediate improvement of the patient's symptoms. A 2-month-old girl was diagnosed with a massive, amblyogenic orbital tumor which was removed intact via an inferior transconjunctival orbitotomy after magnetic resonance imaging (MRI) revealed a well-defined mass filling the entire inferior orbit. Histopathologic examination confirmed the diagnosis of orbital capillary hemangioma. A 1-month-old girl developed occlusion amblyopia due to an enlarging subcutaneous tumor of the left upper eyelid. The discrete mass was excised via an eyelid crease approach and confirmed to be an eyelid capillary hemangioma. There were no short-term or long-term complications in either case. In both cases, immediate resolution of occlusion amblyopia and cosmetic disfiguration was achieved. The final visual acuities were 20/20 at 5 years in the first patient and 20/30 at 4 years follow-up in the second patient. Orbital and eyelid capillary hemangiomas can induce profound permanent amblyopia. If the tumor is well-circumscribed, confirmed with orbital imaging, then surgical excision, with immediate resolution of amblyogenic factors, can be considered as a treatment option.     

B-scan ultrasonic evaluation of a dilated superior ophthalmic vein in orbital and retro-orbital arteriovenous anomalies

All patients between 1977 and 1982 who presented with unilateral exophthalmos were evaluated with contact B-scan ultrasonography. Of these, eight patients were diagnosed as having retro-orbital or orbital arteriovenous anomalies (two carotidcavernous sinus fistulas, four dural arteriovenous malformations, and two orbital arteriovenous malformations). On B-scan ultrasound, all of these patients demonstrated a dilated superior ophthalmic vein. None of the other patients with unilateral proptosis demonstrated this finding. With recent advances in treatment of these conditions, early diagnosis becomes increasingly important. Contact B-scan ultrasonography (which is widely available, convenient, and expedient) can be used for early diagnosis of arteriovenous anomalies in the orbit and cavernous sinus areas. Other ultrasonic techniques such as A-scan, standardized A-scan, or immersion B-scan, are equally reliable in the recognition of a dilated superior orbital vein. In the authors' opinion, however, these are less convenient, more time consuming, and require more expertise for similar results.     

Significance of echographic tissue differentiation for orbital surgery

The high degree of accuracy of standardized echography in tissue differentiation of orbital tumors enables the ophthalmic surgeon to determine exactly whether or not orbitotomy is indicated. As a result of the echographic examination the ophthalmologist is optimally informed as to the location, extent, delimitation and nature of the tissue of the tumor, and therefore better able to perform the orbitotomy. Standardized A-scan echography is capable of demonstrating an orbital tumor with 99% accuracy. Its location, limits, and tissue differentiation decide whether conservative or surgical treatment is to be preferred. Orbital tumors in any location can be removed by Kr?nlein's temporal orbitotomy: the wide temporal approach enables even large tumors to be excised in toto. With appropriate care much of the orbital contents can be spared and an optimal functional and cosmetic result achieved.