眼睑恶性肿瘤35例手术治疗与临床体会

目的:体会眼睑恶性肿瘤行Mohs法切除及即期修复的手术效果。方法:对35例35眼眼睑恶性肿瘤行Mohs法切除后根据眼睑缺损范围及部位采用不同方法即期行眼睑成形或再造手术治疗。结果:35例术后眼睑完整,形态及功能基本恢复正常,随访10mo～2.5a,有2例复发。结论:眼睑恶性肿瘤行Mohs法切除后造成眼睑缺损,通过成形或再造行眼睑重建,效果满意,睑板结膜瓣或硬腭黏膜瓣是替代睑板行眼睑再造的适用材料。     

眼睑基底细胞癌的手术治疗

目的 观察眼睑基底细胞癌的手术治疗方法及疗效.设计 回顾性病例系列.研究对象 33例眼睑基底细胞癌患者.方法 对患者分别实施标准切除术(17例)及Mohs显微切除术(16例)治疗,应用游离植皮及上下睑板移行修复加游离植皮修复缺损眼睑.随访观察患者手术后眼睑外观和功能,肿瘤复发率及患者的生存率.主要指标 眼睑功能及肿瘤复发率与生存率.结果 随访6个月～5年,平均25年.29例眼睑修复患者中,28例术后外观满意,1例因瘢痕较重出现下睑轻度外翻;11例游离植皮修复眼睑的患者术后皮肤色泽有差异,但半年内均恢复正常.29例术后眼睑运动基本正常.行标准切除术的病例中1例术后2年肿瘤复发,治愈率为94.12%,Mohs显微切除术的病例术后无1例复发,治愈率为100%;5年内,除1例死于心肌梗塞、1例死于脑血管疾病外,无因眼睑基底细胞癌死亡病例.结论 手术切除是治疗眼睑基底细胞癌的有效方法,Mohs显微切除术效果优于标准切除术.肿瘤切除后,游离植皮、上下睑板的移行修复加游离植皮修复缺损的眼睑,可使眼睑恢复较理想的形态和功能.     

眼睑恶性肿瘤95例诊治分析

目的 回顾性分析眼睑恶性肿瘤的临床、病理学分类以及行Mohs法切除后进行眼睑缺损修复的方法及效果.方法 对近10年来收治的95例(95只眼)眼睑恶性肿瘤进行回顾性分析,其中上睑54例,下睑41例,其中男性46人,女性49人,平均年龄(61.2±16.8)岁(47岁～87岁).所有患者行Mohs法切除后,根据眼睑缺损范围和部位采用不同方法进行眼睑成形或再造.其中66例患者眼睑后层缺损达全长30％～50％,行外眦切开直接缝合;19例患者眼睑后层缺损超过全长50％,分别采用睑板结膜瓣滑行修复、异体巩膜移植修复.采用皮瓣或游离皮片修复眼睑前层缺损;9例患者为眼睑前层缺损,行邻近带蒂皮瓣或游离皮片修补;1例患者眼睑缺损较大仅行带蒂皮瓣转移修复,二期行眼睑再造.结果 95例患者的病理诊断分别为基底细胞癌43例、睑板腺癌30例、鳞状上皮细胞癌16例、恶性黑色素瘤6例.94例患者手术后眼睑完整,形态及功能基本恢复正常;有1例基底细胞癌患者因肿瘤侵及范围较大,术后眼睑畸形明显,6个月后行二期眼睑再造,回复了眼睑基本功能,效果较为满意.所有患者随访10～30个月,有2例患者肿瘤局部复发,无全身转移,经再次手术后均未再复发.结论 眼睑恶性肿瘤多发生于中老年人,其中以基底细胞癌最常见,其次为睑板腺癌和鳞状上皮细胞癌.治疗方法多采取Mohs法切除肿瘤后联合Ⅰ期眼睑缺损修复,达到眼睑形态和功能的恢复.     

带黏膜的鼻中隔软骨在眼睑重建中的应用

目的:探讨自体带鼻黏膜的鼻中隔软骨修复眼睑恶性肿瘤切除后眼睑大范围缺损的疗效。方法:对7例上睑恶性肿瘤切除后用自体带鼻黏膜的鼻中隔软骨修复睑板缺损并重建眼睑。结果:对7例患者术后随访6mo～2a,带鼻黏膜的鼻中隔软骨生长良好,重建的眼睑外观良好和功能不受影响。结论:自体带鼻黏膜的鼻中隔软骨修复眼睑恶性肿瘤切除后眼睑大范围缺损,手术效果好,而且是一种方便、损伤小的眼睑重建手术。     

眼睑基底细胞癌的手术切除及缺损即期修复

目的探讨眼睑基底细胞癌的手术切除及缺损修复方法。方法采用冰冻控制下手术切除肿瘤,眼睑缺损应用“Ｏ－Ｚ”成形术、改良Ｃｕｔｌｅｒ－Ｂｅａｒｄ和Ｈｕｇｈｅｓ术等不同手术方式即期修复。结果１９例患者术后随访１～１０年,无一例复发,所有患者眼睑外形满意,睑裂形态接近正常。结论采用冰冻控制下手术切除眼睑基底细胞癌,术中及时修复缺损的方法是安全可行的     

眼睑恶性肿瘤诊疗中应关注的几个问题

眼睑恶性肿瘤发病率较高,临床表现复杂多样,术前难以确诊,针刺活检有助于判断眼睑恶性肿瘤类型,指导手术选择.手术切除是治疗眼睑肿瘤的首要方法,但对手术方法选择和切缘控制等仍存在不同看法.快速病理控制切缘的手术方法(Mobs法)能保证在完整清除肿瘤的前提下,掌握组织的最佳切除量.术中眼组织缺损即期修复是眼睑恶性肿瘤治疗的重要环节,手术医生需具备良好的眼整形外科技术,根据缺损的范围、部位和层次等灵活选用合理的修复方法,才能取得肿瘤根治和眼睑功能重建并举的效果.术后应长期随访,及时发现肿瘤复发情况并积极处理,可明显降低患者的转移率和致死率.     

异体巩膜移植修复眼睑缺损临床观察

目的 观察同种异体巩膜及自体皮瓣移植修复眼睑恶性肿瘤组织学控制性切除及严重眼外伤造成眼睑缺损的远期效果。方法 22例(22只眼)眼睑缺损患者，全部用异体巩膜及自体皮瓣移植行眼睑修复。结果 术后随访5个月～16年。13例恶性肿瘤患者以及9例严重外伤后眼睑完全或大部缺损患者。眼睑修复重建后均无功能障碍。其中眼睑恶性肿瘤患者均无复发。结论 组织学控制性切除眼睑肿瘤疗效确切，异体巩膜移植加自体皮瓣移植重建眼睑有利于恢复眼睑的形态和功能，手术效果良好，总有效率达100％。     

眼睑恶性肿瘤的临床分析

目的分析眼睑恶性肿瘤的临床病理类型和治疗方法。方法对74例眼睑恶性肿瘤患者进行病例回顾性分析。其中,男性35人,女性39人,肿瘤部位:右眼38人,左眼36人,上睑25人,下睑49人,年龄28岁～84岁,平均60.74岁。病理诊断示:基底细胞癌39例,睑板腺癌22例,鳞状上皮细胞癌7例,恶性黑色素瘤4例,小细胞癌1例,小细胞恶性淋巴瘤1例。均采用手术治疗,其中6例因肿瘤侵及眶内,行眶内容剜出术,其余病例皆手术切除肿瘤,于术中送冰冻切片控制切缘(Mohs法)以保证术中完全切除肿瘤组织。眼睑缺损一期手术修复。结果6例行眶内容剜出术患者术后遗留明显的眼眶畸形,须二期行眼眶赝复或眼眶畸形整复术。68例术后眼睑外观满意,视功能无影响。结论眼睑恶性肿瘤多发生于老年人,其中基底细胞癌居第一位,其次为睑板腺癌,鳞状上皮细胞癌占第三位。治疗为手术切除加一期缺损修复,睑板结膜瓣滑行修复眼睑缺损具有操作方便、术后眼睑外形满意的优点。     

眼睑肿瘤手术切除与Ⅰ期修复的疗效观察

目的：探讨采用眼睑肿瘤局部切除术+病理检查或术中冰冻切片检查,同时Ⅰ期行眼睑修复手术的临床效果。

方法：对眼睑肿瘤患者92例92眼均行局部切除+Ⅰ期行眼睑修复手术+常规病理检查(37例疑似恶性肿瘤术中行快速冰冻切片检查,如为恶性行按Mohs法切除),并同时Ⅰ期采用自体游离硬腭黏膜移植或Hughes法修复联合眼周皮瓣重建眼睑。

结果：术后病理诊断为良性肿瘤52例,恶性肿瘤40例。全部病例皮瓣及硬腭黏膜植片等全部成活。随访均6mo以上,无1例肿瘤复发。眼睑外观和活动闭合功能满意,获得良好效果。

结论：本组病例中近一半的眼睑肿瘤病例为恶性,故更应及早手术治疗。对疑似恶性的应在术中行冰冻切片明确性质,以利于Ⅰ期切除干净,减少复发、转移。切除后根据眼睑缺损情况行Ⅰ期行修复手术,缺损较大的内层采用硬腭黏膜移植或Hughes法修复,外层皮瓣采用眼周皮瓣滑行、游离皮瓣 、风筝皮瓣、单纯对位缝合等修复。硬腭黏膜移植在上睑修复时应慎重。     

带粘膜鼻中隔软骨重建睑板缺损

目的　探讨带粘膜的自体鼻中隔软骨修复眼睑恶性肿瘤切除后的睑板缺损的疗效。方法　对 12例眼睑恶性肿瘤切除后用带粘膜自体鼻中隔软骨修复睑板缺损并行眼睑重建。结果　 12例术后随访 2 4～ 60月 ,带粘膜的自体鼻中隔软骨生长良好 ,重建的眼睑外观良好和功能不受影响。结论　带粘膜的自体鼻中隔软骨修复眼睑恶性肿瘤术后的睑板缺损效果良好 ,是一种方便而且损伤小的眼睑重建手术。     

Syndrome of the flaccid eyelid (floppy eyelid syndrome

Three patients with increasing swelling of the lateral half of the upper lid associated with chronic papillary conjunctivitis which did not respond to therapy were observed. The history, clinical findings, keratinized epithelial cells in the scrapings and the therapeutic success with a protective shield over night suggested the diagnosis of floppy eyelid syndrome.     

Upper eyelid motility in blepharoptosis and in the aging eyelid

PURPOSE. To study the metrics of lid saccades in blepharoptosis and to distinguish any differences in the dynamics of eyelid movements that are related to the cause of blepharoptosis and to aging. METHODS. The lid and vertical eye saccades of 7 patients with congenital blepharoptosis and those of 18 patients with aponeurogenic blepharoptosis, either involutional or rigid-contact-lens-induced, were recorded with electromagnetic search coils. For each saccade, two parameters were assessed: amplitude and peak velocity. Two age-matched control groups were assessed in the same manner. Repeated measures analysis of variance was used to investigate any observed differences between the included groups. RESULTS. Congenital and rigid-contact-lens-induced blepharoptosis were readily distinguishable from one another, as well as from the age-matched control group, in both lid saccadic amplitude and peak velocity. For example, 40 degrees downward lid saccades in the congenital blepharoptosis group averaged 22.9 degrees +/- 4.0 degrees (SD), whereas 30.0 degrees +/- 4.7 degrees lid saccades were made by the age-matched control group. The subjects in the two groups with aponeurogenic blepharoptosis also made lid saccades that were distinctive for their group (P: < 0.02), in both amplitude and peak velocity. For 40 degrees downward saccades in involutional and rigid-contact-lens-induced blepharoptosis, lid saccadic amplitude averaged 32.7 degrees +/- 4.3 degrees and 40.3 degrees +/- 3.5 degrees, respectively. Lid saccadic peak velocity declined significantly with age. Lid saccadic peak velocity for 40 degrees upward saccades in the younger control group averaged 401.7 +/- 11.4 deg/sec, whereas the older control group achieved an average peak velocity of 360.7 +/- 60.4 deg/sec. The lid saccadic dynamics in the involutional blepharoptosis group proved to be similar (P: > 0.05) in saccadic amplitude and peak velocity to those of age-matched controls. CONCLUSIONS. In different forms of blepharoptosis, distinctive metrics of lid saccades occur. The current data suggest that involutional blepharoptosis is not a consequence of normal age-related changes in eyelid function.     

Malakoplakia of the eyelid

A 35-year-old white man, on immunosuppressive medications for 3 1/2 years following a renal transplant, presented with a whitish-yellow mass at the medial end of the left lower eyelid. An initial incisional biopsy was performed that was misinterpreted as granular cell myoblastoma. The mass was subsequently excised and histopathologic examination revealed malakoplakia. A more extensive recurrent lesion was excised one year later. About two years after the resection of the original lesion the patient died of complications of chronic renal failure. At autopsy there was no evidence of malakoplakia either of the eyelid-or systemically. This is the first case reported of eyelid involvement by malakoplakia, a histiocytic disorder with pathognomonic histopathologic features.     

Osteolipoma of the eyelid

A 50-year-old woman presented with a nodular swelling on her right upper eyelid. The tumour was diagnosed as osteolipoma histologically after resection. Osteolipoma is a very rare variant of lipoma and only a few cases affecting the head and neck are reported in literature. To the best of the author's knowledge this is the first reported case of osteolipoma of the eyelid.     

Poroma of the eyelid

A 71-year-old white woman sought treatment for poroma of the right lower eyelid. Excisional biopsy was performed, and the specimen had histologic features consistent with poroma. One year after excision, there has been no recurrence of the lesion. Clinicians should be aware that poroma can occur in regions other than the hands and feet.     

Trichoblastoma of the eyelid

A 50-year-old woman developed a slow-growing tumor of the right medial canthus. Excisional biopsy and histologic examination showed a trichoblastoma. This nodule was excised using Mohs micrographic and reconstructive surgery. Trichoblastoma is a rare, slow-growing neoplasm derived from the hair follicle. Though rarely undergoing malignant transformation, these nodules histologically resemble basal cell carcinoma and generally require complete excision.     

Anthrax of the eyelid

Anthrax is a rare infection that is transmitted to humans from animals or animal products. In its cutaneous form it may produce lesions of the eyelids which can lead to cicatricization and ectropion. Exophthalmos, optic atrophy and panophthalmitis have also been reported. A case of anthrax affecting the eyelid of a patient seen by the author in Kabul, Afghanistan, is presented.     

Myolipoma of the eyelid

Background: This report describes the pathology of a myolipoma which occurred in the eyelid. Myolipoma is a benign hamartomatous tumour in which smooth muscle cells are interspersed with adipocytes. · Patient details: an irregular yellowish tumour (30×25 mm) with ill-defined borders had been present for 50 years in the medial part of the left lower eyelid of a 67-year-old woman. The tumour was excised and studied by conventional histology, immunohistochemistry and transmission electron microscopy. · Results: The tumour was formed by bundles of spindle-shaped cells with cigar-shaped nuclei intermingled with multiloculated clear cells containing small eccentric nuclei. By immunohistochemistry, positive staining of the spindle cells was restricted to smooth muscle actin and desmin; the clear cells were non-reactive with the immunohistochemical panel, but fat was identified within the cytoplasm. The ultrastructural features of the spindle cells were those of a leiomyoma, while the clear cells were classified as adipocytes. · Conclusion: This tumour was considered to originate from the media of blood vessels within the tumour. Received: 2 June 1997 Revised version received: 6 October 1997 Accepted: 15 October 1997