结膜入路外眦切开法摘除眼眶内海绵状血管瘤

目的采用结膜入路及外眦皮肤切开法摘除眼眶内海绵状血管瘤，评价结膜入路及外眦切开法的临床应用价值。方法通过靠近肿瘤部位的穹隆结膜及外眦皮肤切开的方法，对位于眼眶前部、眶后段或偏上、偏下之海绵状血管瘤进行摘除。结果6例患者的眼眶内海绵状血管瘤均顺利完整地摘除，保持或恢复视力。结论经结膜入路外眦切开法是一种值得采用的摘除眼眶内海绵状血管瘤的手术方法。     

外眦皮肤结膜径路摘除眶肌锥内海绵状血管瘤

目的　探讨眶肌锥内海绵状血管瘤的改良手术治疗方法。方法　 12例 (12眼 )眶肌锥内海绵状血管瘤经术前CT或B超进行定性定位诊断 ,采用外眦皮肤 结膜径路手术方式摘除。结果　 12例眶肌锥内海绵状血管瘤均成功摘除 ,视力均有提高 ,无严重并发症。结论　外眦皮肤 结膜径路摘除眶肌锥内海绵状血管瘤较简便易行 ,治疗效果良好。     

结膜入路摘除肌锥内海绵状血管瘤

目的探讨经结膜入路摘除肌锥内海绵状血管瘤的手术方法、手术适应证、手术技巧及并发症。方法回顾性分析自1997年5月以来我院手术治疗的海绵状血管瘤22例，其中15例肌锥内海绵状血管瘤经结膜入路手术。结果经结膜入路摘除肌锥内海绵状血管瘤15例，手术顺利，无明显并发症。结论结膜入路是摘除肌锥内海绵状血管瘤的一种安全、有效的手术方法，关键在于术前对肿瘤性质、粘连程度的正确判断和手术操作的技巧。     

眼眶静脉性蔓状血管瘤手术体会

目的 探讨眼眶静脉性蔓状血管瘤的手术方法及疗效。方法 对我院2例眼眶静脉性蔓状血管瘤患者,采用外眦延长联合结膜切口进行手术摘除。结果 肿瘤范围广,粘连紧密而大部分切除。术后眼球突出改善,轻度上睑下垂,3月后恢复。无复发。结论 眼眶静脉性蔓状血管瘤采用外眦延长联合结膜切口进行手术摘除,创伤小、外观影响及并发症少,可取得较满意的临床效果。     

经结膜入路摘除肌锥内海绵状血管瘤

目的：探讨经结膜入路摘除肌锥内海绵状血管瘤的手术方法，手术适应证，手术技巧及并发症。方法：回顾性分析1999年7月到2000年5月我院手术治疗的海绵状血管瘤21例，其中13例肌锥内海绵状血管瘤采取经结膜入路手术。结果：经结膜入路摘除的13例肌锥内海绵状血管瘤，手术顺利，时间仅需15－20min，无明显并发症。结论；结膜入路是摘除肌锥内海绵状血管瘤的一种安全，有效的手术方法，关键在于术前对肿瘤性质，粘连程度的正确判断和手术操作的技巧。     

复杂眼眶良性肿瘤手术方法探讨

目的：复杂眼眶良性肿瘤手术方法的探讨。方法：对我院2001年11月至2002年6月7例复杂眼眶良性肿瘤病人，视神经鞘瘤1例，脑膜瘤2例，泪腺混合瘤1例。广泛静脉蔓状血管瘤1例，眶顶巨大血管瘤1例，眶尖肌锥内侧海绵状血管瘤1例，采用外眦延长切口、结膜切口或二者联合切口进行手术切除，并观察其临床疗效。结果：肿瘤完全切除6例，1例肌锥内血管瘤紧密包绕视神经为保存视力而大部分切除。术后眼球突出均消失，部分有短暂性复视、上脸下垂、眼球运动受限．3～6月恢复，6例视力不变，1例因脑膜瘤包绕视神经与神经一并切除而视力丧失。结论：复杂眼眶良性肿瘤采用外眦延长切口、结膜切口或二者联合切口进行手术切除，创伤小、外观影响少、并发症少、成功率高，可取的满意的临缶床效果。     

非开眶术摘除肌锥内海绵状血管瘤的临床观察

目的 探讨非开眶术摘除肌肉锥体内海绵状血管瘤的手术方法及手术适应证。方法 回顾性分析1997年3月到2001年4月我院手术治疗眼眶肌肉锥体内海绵状血管瘤12例。结果 非开眶术摘除12例肌锥内海绵状肿瘤顺利摘除，无明显并发症。结论 非开眶术是摘除肌锥内海绵状血管瘤的一种安全、简便而有效的手术方法。     

经结膜入路摘除肌锥内海绵状血管瘤临床分析

目的 探讨经结膜入路摘除肌肉锥体内海绵状血管瘤的适应证选择、手术方法及技巧。方法 回顾性分析2003年1月～2004年12月我院经结膜入路摘除肌肉锥体内海绵状血管瘤21例。结果 经结膜入路均可顺利摘除肌锥内海绵状血管瘤，无明显并发症。结论 通过术前准确定性，正确定位，判断粘连程度，来选择结膜入路可以安全而简便地摘除肌锥内海绵状血管瘤。     

经结膜入路眼眶海绵状血管瘤切除术的研究

目的：：探讨经结膜入路眼眶海绵状血管瘤切除术的手术方式和注意事项,并观察其疗效及并发症。方法：采用回顾性方法分析2007-01/2013-11的74例眼眶海绵状血管瘤患者。术前经CT或MRI联合彩色多普勒检查确诊。手术全部采用结膜入路,鼻下、颞下及正下方肿瘤采用下穹窿结膜切口,颞上象限的肿瘤采用颞侧结膜入路,鼻上及上方肿瘤采用内上方穹窿结膜入路,暴露后钳夹肿瘤,轻轻挽出瘤体;如肿瘤与周围组织粘连紧密,则采用分步切除的方法：先切除部分瘤体,然后直视下再切除残留的肿瘤。结果：74例海绵状血管瘤的术前确诊率达到100％。肌锥内58例(78％),肌锥外16例(22％),其中颞上方12例(16％),上方16例(22％),鼻下、颞下方及正下方46例(62％),肿瘤直径8~59mm,手术全都采用结膜入路,其中下穹窿结膜入路46例,颞侧结膜入路12例,鼻上方结膜入路16例,有9例患者采取先摘除1/3瘤体,瘤体缩小后,再摘除剩下的肿瘤。8例患者术后视力下降,其中6例术后半年视力恢复。5例患者术后视力提高,术后无眼球突出,球结膜充血水肿10例,1例患者术后瞳孔不等大,复视6例。结论：经结膜入路手术切除肿瘤适用于除眶尖部以外的所有眼眶海绵状血管瘤,结合直视下分步切除肿瘤法,可有效降低手术风险,提高手术安全性。     

眼眶海绵状血管瘤的手术入路选择和疗效分析

目的:探讨眼眶内不同位置的海绵状血管瘤(OCH)手术入路的选择、治疗效果以及并发症。方法:回顾性分析空军军医大学第二附属医院眼科2016-01/2021-08经手术摘除并经病理确诊为OCH的患者128例128眼临床资料,通过术前影像学检查(CT/MRI)确定OCH在眼眶内的位置,以此来选择不同的手术入路,并分析术后疗效及并发症的发生率。结果:OCH发生于眼眶内的位置：肌锥内82眼,肌锥外46眼。根据肿瘤所在象限分类：外上象限24眼,外下象限38眼,内上象限28眼,内下象限12眼,中央区26眼。手术入路的选择：(1)肌锥内OCH:结膜入路53眼,外侧开眶入路22眼,外侧开眶联合内侧结膜入路5眼,皮肤入路1眼,鼻内镜经鼻入路1眼;(2)肌锥外OCH:皮肤入路29眼,结膜入路12眼,外侧开眶入路5眼。术后疗效：除1眼肿瘤残留外,其余127眼肿瘤均完整摘除。术后并发症：(1)眼球运动受限16眼,其中结膜入路11眼、外侧开眶入路4眼、外侧开眶联合内侧结膜入路1眼;(2)视力下降9眼：其中结膜入路3眼、外侧开眶入路6眼;(3)瞳孔散大9眼：其中结膜入路4眼、外侧开眶入路5眼;(4)眶内出血3眼：均...     

改良Ⅰ期重睑成形联合内眦赘皮矫正术的疗效探讨

目的:探索一种设计简单、操作灵活、效果确实的Ⅰ期重睑成形联合内眦赘皮矫正术的新方法,以期达到自然、美观的眼部外形.方法:选取2011-09/2015-05采用Ⅰ期重睑成形术联合内眦赘皮开大术矫治单睑合并内眦赘皮患者62例124眼,包括对双上睑单睑常规行切开法重睑术,向内眦部延长重睑线切口,将内眦切口隐蔽在重睑线内;随后松解纵形内眦韧带,并重新定位理想的内眦形态,以减少内眦部皮肤张力;再根据新定位内眦形态适度去除多余皮肤组织,同时矫正双上睑单睑合并内眦赘皮外形.术后3mo~1a对患者进行随访,随访时间点分别为3、6mo,1a,在以上时间点对患者双上睑重睑的形态及内眦形态、内眦瘢痕等进行观察.结果:患者57例114眼获得3mo~1a的完整随访.通过对随访的57例114眼患者的重睑形态进行评估,永久性重睑、内眦赘皮矫正充分,形态满意者51例102眼,内眦赘皮部分矫正、形态改善者6例12眼,所有随访患者均未见内眦赘皮复发及严重瘢痕增生.结论:将内眦开大术与重睑成形术同期施行,内眦开大充分,切口隐蔽,可按实际皮肤量切除皮肤,术后切口瘢痕隐蔽,能够有效地解决内眦部皮肤的张力分布,获得永久性重睑和自然的内眦开大效果,是矫正单睑合并内眦赘皮的理想手术方法.     

经结膜入路行眼眶爆裂性骨折整复疗效分析

目的:探讨经结膜入路行眼眶爆裂性骨折整复手术的疗效及优势。方法:回顾性分析46例眼眶内壁、下壁骨折患者经结膜入路行眶壁骨折整复的手术方法和效果。结果:术后所有患者视力无明显下降;在31例复视患者中,术后12mo,3例存在向上方及颞侧极度转动时复视;23例眼球内陷患者中,术后3~12mo,15例患者双眼眼突度相差≤2.0mm,8例患者术眼低于健眼2.0mm以上;所有患者外观均无可见的手术瘢痕及外眦畸形。结论:经结膜入路行眼眶爆裂性骨折整复手术,方法安全可靠,入路简单,操作方便,并发症少,患者面部没有瘢痕。     

Ipsilateral orbital cavernous hemangioma and choroidal hemangioma

PURPOSE: A unique case of simultaneous ipsilateral choroidal and orbital hemangiomas is described. METHODS: A 71-year-old man was found to have a left orbital intraconal mass while being worked up for intractable headache. He also had a left juxtapapillary choroidal hemangioma which did not cause any leakage to macular area. RESULTS: The left intraconal tumor was removed by medial transconjunctival orbitotomy. Histopathological examination revealed cavernous hemangioma. The ipsilateral choroidal hemangioma was managed by observation only. During 15 months of follow-up, there has been no growth or accumulation of subretinal fluid. CONCLUSIONS: The occurrence of orbital cavernous and choroidal hemangiomas on the same side suggests common pathogenic derangement acting on two different sites.     

The transconjunctival approach to a large retrobulbar cavernous hemangioma of the orbit

Cavernous hemangiomas are one of the most common benign tumors of the orbit in adults. We report a case of a longstanding retrobulbar hemangioma that was removed successfully through a temporal transconjunctival approach combined with lateral canthotomy. A 45-year-old female patient, with a 15-year history of slowly progressive proptosis and decreased visual acuity of the left eye, had a corrected visual acuity of finger count at 50 cm OS, compared with 1.0 OD. Exophthalmometry by the Nagle's method measured 15 mm OD by 26 mm OS. Magnetic resonance imaging (MRI) revealed a well-encapsulated retrobulbar main mass, 2.3 x 3.0 x 3.7 cm in size along with multiple small satellite nodules that were displacing the optic nerve and globe superiorly. The tumors were removed through a superotemporal transconjunctival approach combined with lateral canthotomy. Pathological examination revealed an intraorbital cavernous hemangioma. The patient was free of visible scars, proptosis and any other noticeable complications at her last follow-up, 6 months after surgery.     

Cavernous Hemangioma of the Bony Orbit

Purpose: To study the clinical features, diagnosis and management of intraosseous cavernous hemangioma of the orbit. Methods: Five cases of intraosseous cavernous hemangioma seen in our hospital from Jan 1, 1986 to Dec 31, 2000 were reviewed. Results: Among all five cases, two were male and three were female. The mean age was 47.6 years old, ranging from 39.0 to 55.0 years. The left orbit was affected in 4 cases and the right one in 1 case. The bony involvement occurred in frontal bone (two cases), zygomatic bone (two cases) and sphenoid bone (one case). A painless, slowly enlarging hard bony mass fixed to the bone with no pulsations was the main clinical sign. The x-ray and CT appearance of intraosseous cavernous hemangioma of the orbit were characteristic and usually diagnostic. The differential diagnosis of it included fibrous dysplasia, eosinophilic granuloma, multiple myeloma and metastatic carcinoma. Treatment is local removal of the bone containing the tumor. Conclusions: Intraosseous cavernous hemangioma is a rare tumor of the orbit and usually has good surgical result. Eye Science 2005;21:147-151.     

Tc-99m labeled red blood cells scintigraphy: a diagnostic method for orbital cavernous hemangioma.

PURPOSE: To evaluate Tc-99m labeled red blood cells scintigraphy (Tc-99m RBC scintigraphy) as a diagnostic method for orbital cavernous hemangioma. PATIENTS AND METHODS: Retrospective analysis of the medical records of all patients who were diagnosed as suffering from orbital cavernous hemangioma over the last 16 years. RESULTS: Medical records of 12 patients with orbital cavernous hemangioma were identified. In all twelve patients, the tentative diagnosis of orbital cavernous hemangioma was made by CT scan. In all of them, the diagnosis was established by Tc-99m RBC scintigraphy, demonstrating a typical picture of "perfusion blood- pool mismatch" (This is normal radionuclide angiography, followed by a variable radionuclide uptake during the early blood-pool study and an intensive radionuclide uptake during the delayed blood-pool study). The tumor was surgically removed in all 12 patients. This diagnostic method was found to be reliable as no single case was recorded in which the preoperative diagnosis was not confirmed pathologically after surgical removal of the tumor. CONCLUSIONS: Tc-99m RBC scintigraphy is a reliable method for diagnosing orbital cavernous hemangioma. It should be included in our arsenal of diagnostic techniques, particularly for cases which are otherwise difficult to diagnose.     

Osseous cavernous hemangioma of the superior orbital rim

A 53-year-old male presented with a bony lesion over the superior orbital rim increasing in size over several months. CT imaging showed a circumscribed, osseous lesion involving the outer table of the right frontal bone and superior orbital rim with a honeycomb appearance. Anterior orbitotomy revealed an osseous lesion along the superior orbital rim with purple cavernous spaces. Histopathological examination demonstrated cavernous vascular channels with variably-sized lumens and variably-thickened vascular walls interspersed among bony trabeculae consistent with an osseous cavernous hemangioma.     

不同手术入路摘除眼眶内海绵状血管瘤23例分析

目的:探讨眼眶海绵状血管瘤的临床特点、术前定性诊断与手术进路的适应证选择、手术方法及技巧。方法:回顾性分析2002-03/2006-03荆州市中心医院眼科手术治疗的海绵状血管瘤23例,其中,男10例,女13例;右眼9例,左眼14例;年龄18～63(平均41.2)岁;以渐进性眼球突出和视力下降为主要临床表现。10例采用前路结膜切口开眶入路,6例采用前路皮肤切口开眶入路,7例采用外侧开眶入路。结果:96%(22/23)根据超声波和CT可作出术前准确诊断。70%(16/23)采用前路开眶,30%(7/23)采用外侧开眶顺利摘除肿物。结论:眼眶海绵状血管瘤术前基本上可作出诊断,安全、有效地摘除海绵状血管瘤选择手术进路很重要,关键在于术前对肿瘤性质、位置、粘连程度的正确判断和手术操作的技巧,大部分的病例不需外侧开眶即可顺利摘除肿物。     

Surgical outcomes of transconjunctival anterior orbitotomy for intraconal orbital cavernous hemangioma

Purpose

To describe surgical outcomes for transconjunctival anterior orbitotomy for intraconal cavernous hemangiomas.

Methods

The medical records of 9 consecutive patients with intraconal cavernous hemangiomas who underwent surgical removal by transconjunctival anterior orbitotomy were retrospectively reviewed. The conjunctiva was incised and retracted with a traction suture. For large tumors, a rectus muscle was temporarily disinserted. Tenon''s capsule was separated and the tumor was removed with a cryoprobe or clamp. Surgical outcomes, positions of the tumors, methods of approach, and intra- and post-operative complications were evaluated.

Results

The mean follow-up period was 33 ± 6.8 months. No bony orbitotomy was used in this technique and the cosmetic results were very satisfactory. All tumors were removed intact. In 4 patients, tumors were extirpated with the aid of a cryoprobe. No patients had residual proptosis or limitation of ocular movement. No signs of recurrence were noted in any cases at 33 months follow-up. No serious or permanent complications were observed during or after the operation.

Conclusions

Transconjunctival anterior orbitotomy is an important surgical procedure in the treatment of intraconal cavernous hemangiomas. It can produce an excellent result, even if the posterior border of the tumor abuts the orbital apex.