眼部肿瘤的性质鉴别及治疗(附65例病例分析)

为了明确眼部肿瘤的性质和范围，以确定手术方式，分析６５例眼部肿瘤的临床资料，主要观察其眼部情况，Ｂ超和ＣＴ等影像学表现。结果发现，不同性质的肿瘤有不同的眼部表现，影像学检查在眼眶和眶周均能发现病变，并能做出定位和定性诊断。根据病变性质，范围及既往手术情况采取手术切除肿瘤方式和其它手术方式。５９例行手术治疗，另外６例采取其它治疗。手术方式：局部肿瘤切除１３例，外侧开眶１２例，经颅入路开眶２例，眶内容切除５例，眼球摘除２７例。手术结果提示：经颅开眶并发症多，应严格掌握适应症。良性肿瘤采取手术切除肿瘤方式是缓解眼部症状的唯一方法，恶性肿瘤采用综合治疗效果比较满意。     

眼部肿瘤的性质鉴别及治疗

为明确眼部肿瘤的性质和范围，以确定手术方式，分析６５例眼部肿瘤的临床资料主要观察其眼部情况，Ｂ超和ＣＴ等影像学表现。结果发现，不同性质的肿瘤有不同的眼部表现，影像不晨眼眶和眶周均能发现病变，并能做出定位和定性诊断。根据病变性质，范围及既往手术情况采取手术切除肿瘤和其它手术方式，５９例手术治疗，另外６例采取其它治疗。手术方式：局部肿瘤切除１３例，外侧开眶１２例，经颅入路开眶２例，眶内容切除５例，眼球     

眼眶占位性病变150例临床分析

目的探讨眼眶占位性病变的病理学分类、分布及手术方式。方法回顾性分析150例眼眶占位性病变的病理学特点及其手术方式。结果良性病变124例(82.67%),占前3位的依次为海绵状血管瘤41例(27.33%),皮样囊肿和表皮样囊肿30例(20.00%),泪腺多形性腺瘤14例(9.33%)。恶性病变26例(17.33%),前2位的依次为脉络膜黑色素瘤11例(7.33%),淋巴瘤8例(5.33%)。前路开眶117例(80.14%)。结论眼眶占位性病变中脉管源性肿瘤最常见,其中第一位是海绵状血管瘤,原发性恶性病变中最多见的为淋巴瘤,眼眶肿瘤的手术治疗以前路开眶手术入路多见。     

151例老年人眼眶内肿瘤临床分析

目的：分析老年人眼眶肿瘤的临床特点、病理学分类、手术方式及治疗效果。方法回顾性分析2004年1月至2014年3月收治的151例手术治疗的60岁以上老年人眼眶肿瘤患者。结果老年人眼眶肿瘤以眼球突出为主,可伴有眼斜、视力下降等。影像学检查可明确诊断肿瘤位置及大小,并决定手术方式。其治疗手术摘除包括前路开眶97例、外侧开眶39例、内外侧联合开眶10例、眶内容剜除5例。术后病理结果确定肿瘤性质,其中良性肿瘤103例（68．21％）,前3位依次为海绵状血管瘤、泪腺多形性腺瘤、炎性假瘤及慢性炎症;恶性肿瘤48例（31．79％）,前3位依次为恶性淋巴瘤、泪腺腺样囊性癌、泪腺多形性腺癌。结论老年人眼突应尽早行影像学检查排除眶内占位。治疗首选开眶手术,根据肿瘤位置、大小及患者可耐受程度选择手术方式。恶性淋巴瘤是60岁以上老年人最常见的眼眶恶性肿瘤。     

经结膜入路摘除眼眶海绵状血管瘤的疗效观察(附39例临床报告)

目的:观察眼眶海绵状血管瘤经结膜入路摘除的手术疗效,并探讨其与影像学定位的关系.方法:回顾性分析39例经结膜入路摘除的眼眶海绵状血管瘤患者的临床资料,对其临床和影像学特征、手术效果及选择标准进行总结.结果:所有患者的海绵状血管瘤均位于眼球后水平或紧邻眼球.CT和MRI显示39例眼眶海绵状血管瘤均位于肌肉圆锥内,多呈类圆形且边界清楚.36例完整摘除患者术前影像学检查显示肿瘤均位于肌肉圆锥内,粘连程度轻,无粗大引流静脉;1例患者虽然完整摘除但术后视力丧失,术前影像学检查显示肿瘤存在粗大引流静脉;另2例患者部分切除,术前影像学检查显示肿瘤与周围组织粘连紧密.手术成功率92.3%;9例术前视力减退患者中有6例视力有提高;全部32例眼球突出患者均完全缓解.疗效改善者32例(82.1%),疗效不变者5例(12.8%),疗效恶化者2例(5.1%).结论:球后肌肉圆锥内的海绵状血管瘤可以通过结膜入路成功摘除.但如果影像学检查显示肿瘤紧邻眶尖、与眶周组织粘连紧密、或有粗大引流静脉,则需要选择其他手术入路.     

外侧开眶眼眶肿瘤摘除术26例临床分析

目的探讨外侧开眶治疗眼眶肿瘤与手术效果的关系。方法分析26例眼眶肿瘤手术径路、效果及并发症。结果26例均完全摘除肿瘤,并发症以眼球运动受限、视力下降为主。结论外侧开眶术野暴露清楚、易于切除病变。     

眼眶肿瘤采用不同手术入路治疗的临床疗效观察

目的:观察不同手术入路治疗眼眶肿瘤的临床效果.方法:收集2015年1月～2020年1月在弋矶山医院住院手术的眼眶肿瘤患者77例(79眼),根据肿瘤的位置、大小和性质不同,采用前路开眶、外侧开眶及眶内容物剜除术,观察术中肿瘤的切除是否完整、术后并发症如瞳孔的改变、上睑下垂及眼球运动受限情况、术后随访6个月的复发情况.结果...     

标准化A/B超在海绵血管瘤和神经鞘瘤鉴别诊断中的价值

医学影像学是利用某种能量,穿过人体形成图像,从而显示内部正常结构和病变的检查方法,是诊断学的一项重大突破.对于眼眶肿瘤,术前利用影像学检查,不仅能对眶内肿瘤作出定位诊断,而且对于许多肿瘤尚可作出明确的定性诊断及鉴别诊断,这对于肿瘤摘除的麻醉方式、手术入路和手术方式的选择有极其重要的意义[1].     

不同手术入路摘除眼眶海绵状血管瘤的效果

目的 探讨不同入路手术摘除眼眶海绵状血管瘤的手术效果.方法 回顾性分析189例经手术摘除的眼眶海绵状血管瘤患者的临床资料,对眼眶海绵状血管瘤患者的手术人路、手术技巧及手术效果进行总结.结果 所有患者的海绵状血管瘤均经手术摘除.行经结膜入路前路开眶术121例,其中完整摘除肿瘤119例,肿瘤大部摘除2例;术后视力改善62例,视力稳定55例,视力丧失和减退4例(2例因大出血致视力丧失、2例因术中牵拉后瞳孔永久性散大而致视力减退).行经皮肤入路前路开眶术25例,均完整摘除肿瘤,术后患者视力改善14例,视力稳定11例.行外侧开眶术37例,其中完整摘除肿瘤34例,肿瘤部分摘除3例;术后视力改善21例,视力稳定13例,视力丧失和减退3例(1例因术中损伤视神经致视力丧失、1例因术后发生视网膜中央动脉阻塞致视力骤降、1例因术中牵拉后瞳孔永久性散大而致视力减退).行内外侧联合开眶术5例,其中完整摘除肿瘤3例,肿瘤大部摘除2例;术后视力改善1例,视力稳定3例,视力减退1例(因术中牵拉后瞳孔永久性散大而致视力减退).内侧开眶术1例,完整摘除肿瘤,术后视力稳定.结论 选择合适的手术入路可成功地摘除眼眶海绵状血管瘤.     

鼻窦肿瘤致眼球突出50例临床分析

目的探讨鼻窦源性眼眶肿瘤的临床表现、诊断及治疗方法.方法回顾分析50例侵犯眶内的鼻窦肿瘤临床表现,诊断治疗及手术入路.结果50例均有不同程度突眼,复视20例,视力下降10例,上睑下垂3例.球结膜水肿10例,鼻部症状12例.CT检查表现骨质缺损,软组织块影;MRI检查鼻窦、眼眶肿块信号连续.所有患者均行手术治疗,经口腔进路35例,内眦开眶5例,眉弓开眶5例,经口腔加内侧联合开眶5例,49例眼球复位,1例眶内容物剜出.结论CT、MRI检查,局部穿刺对定位定性诊断均有助,良性肿瘤首选经口腔,内眦眉弓进路.恶性肿瘤联合进路.可提高治疗水平.     

Manage orbital apex lesions via posterior lateral orbitotomy

Background: Technically it is most challenging to reach orbital lesions located in the apex. We intend to show that posterior lateral orbitotomy is a valid and effective surgical approach to manage orbital apex lesions. Methods: Posterior lateral orbitotomy was performed on 9 patients, including 4 males and 5 females, who were diagnosed with orbital apex tumors located lateral to optic nerves. Results: For the 9 patients diagnosed with orbital apex lesions, the apical tumors were accessed and resected via posterior lateral orbitotomy. En bloc resection of apical lesions was achieved in 7 patients, whereas subtotal resection was done in 2 patients whose tumors were too close to the surrounding vital structures. There is no mortality, postoperative ptosis or lateral rectus disorder. Exophthalmos symptoms disappeared completely after the surgery, and visual acuity or visual field was improved in most patients. Conclusion: Posterior lateral orbitotomy is a valid and reliable alternative for extraorbital approaches in managing the orbital apex lesions as it provides sufficient exposure to the lesions and incurs minimum cosmetic defects and damages to normal tissues.     

Manage orbital apex lesions via posterior lateral orbitotomy

As surgical approaches accessing orbital apex carry significant risk and require strong expertise and skills,it is important for surgeons to share their know-how and to evaluate the surgical interventions they practiced on a number of patients.We retrospectively studied 9 cases of orbital apex lesions which were excised via posterior lateral orbitotomy.     

对比经结膜入路开眶术和内外联合开眶术摘除视神经内侧眼眶海绵状血管瘤的临床效果

目的 评估经结膜入路前路开眶术,内外侧联合开眶术,2种不同入路手术摘除肌锥内视神经内侧眼眶海绵状血管瘤的临床效果。方法 回顾性分析云南省第二人民医院2009年09月至2019年09月收治的68例眼眶海绵状血管瘤,根据术式分为A、B 2组。A组为结膜入路前路开眶术共33例,B组为内外侧联合开眶术共35例,评估2组患者在平均住院时间、手术时间、手术操作空间、术中出血量、肿瘤完整摘、术后并发症等指标,差异无统计学意义（P> 0.05）。结果 A组平均住院天数为（5.03±1.63）d,B组为（8.34±2.13） d,两者相比差异有统计学意义（t=-4.926, P=0.000）。A组平均手术时间为（55.62±5.43）min, B组为（109.21±13.72） min,两者相比差异有统计学意义（t=-16.428,P=0.000）。手术操作空间用注水法测量,用所注水的体积表示,A组平均为（5.22±0.21） mL,B组平均为（16.501±1.22） mL,两者相比差异有统计学意义（t=-48.362,P=0.000）。术中出血量：A组平均为（17.22±1.65）mL,B组平...     

Image-guided resection of cerebral cavernous malformations

Cavernousmalformations (CMs) generallycategorizedascerebralvascularmalformations ,andrepresentroughly9%ofallcerebrovascularmalformations 1　Themostcommonclinicalpresentationisseizureoccurringin 2 5 %to 5 0 %of patients Intracerebralhemorrhageisalsocommonlyseeninthese patients,withanannualhemorrhagerateof 0 2 5 %-2 3 %perpatient 2 　Withtheadventofmagneticresonanceimaging (MRI) ,diagnosisofCMinmostcasesishighlyaccurate Dealingwiththeselesionsespeciallyintheso called“healthypatients” ,neu…     

完全性肺静脉异位引流的解剖变异及外科处理

目的 探讨完全性肺静脉异位引流(TAPVC)的解剖变异及相应的手术方式.方法 通过对1981年4月至2010年7月143例患儿的临床观察,分析TAPVC的解剖特征.术前诊断主要依据心脏超声检查,部分病例经心导管检查、MRI或三维CT重建确诊.手术方法除典型术式,根据不同解剖亚型采用改良Warden术等不同术式的矫治术.结果 143例患儿解剖分型结果中:(1)心上型71例,按照TAPVC汇入上腔静脉的路径细分为4个亚型:A型(左行),65例;B型(右行),3例;C型(双行),2例,左右肺静脉分别于上腔静脉的左右侧汇入;D型(后行),1例,肺静脉于无名静脉与上腔静脉汇合部后方入上腔静脉.(2)心内型58例,分3个亚型:A型,冠状静脉窦型(20例).B型,右心房型(37例).C型,窦房混合型(1例).(3)心下型6例.(4)混合型8例,根据Ujjwal分类法分为:对称型5例;不对称型3例.治疗结果:手术治疗135例,治愈127例(94.1%,127/135).术后院内死亡8例(5.9%,8/135).死因包括低心排综合征致脱机困难、术后肺高压危象合并低心排综合征、肺部感染并发呼吸衰竭.9例出现术后低心排综合征、肺水肿,经治痊愈出院.8例患儿无法耐受手术,内科治疗无效死亡.结论 TAPVC的解剖亚型并不少见,且变异复杂;正确认识其亚型及采取个体化的手术方案,有助于提高治疗效果.

Abstract：

Objective To describe the anatomic variations of total anomalous pulmonary venous connection (TAPVC) and its corresponding surgical techniques.Methods A total of 143 TAPVC subjects were hospitalized from April 1981 to July 2010. Those patients with other complex congenital heart diseases, such as transposition of great artery and single ventricle, were excluded. A pathological diagnosis was made by echocardiography, magnetic resonance imaging, computed tomography, catheterization and intra-operative findings.The specific types of TAPVC were as follows:supra-cardiac (49.7%, 71/143), cardiac (40.6%, 58/143), infra-cardiac (4.2%, 6/143) and mixed (5.6%, 8/143). The subtypes were classified by the pathway of common confluence, distribution of pulmonary vein and their orifice site.The techniques of surgical repairs included modified Warden procedure and pulmonary vein transplantation.Results The patients with supra-cardiac type were further divided into 4 subtypes according to the course of vertical veins and their orifice site:right and left veins forming a common confluence, then draining into vertical and innominate veins (n=65);common confluence of pulmonary vein drainage into superior vena cava through a short vertical vein at the right pulmonary hilus (n=3);right and left pulmonary veins separately draining into superior vena cava (n=2);common confluence draining into innominate vein through a right path beside trachea (n=1). Cardiac types were further divided into 3 subtypes:coronary sinus (n=20), right atrium (n=37) and right atrium & sinus (n=1). Infra-cardiac type had no subtype. Mixed type was more complex and it was further divided into 3 subtypes:bilateral & symmetrical connection (right 2 + left 2, n=5);bilateral & asymmetrical connection (3+1, n=3). Surgical repairs were performed on 135 patients. The surgical mortality of TAPVC was 5.9% (8/135). And there was no late death. The major causes of death were pulmonary infection and low cardiac output syndrome.Conclusion A detailed classification of TAPVC is of great importance for surgical approaches and methodological designs. And an individualized surgical plan yields excellent patient outcomes.     

慢性放射性肠损伤的外科治疗

目的 探讨慢性放射性肠损伤( CRII)外科治疗的方法及临床效果.方法 回顾性总结2001年1月至2010年12月南京军区南京总医院外科连续治疗的206例CRII患者资料.其中男64例,女142例,年龄(50±11)岁.总结手术原因、手术方式、手术并发症及病死率.结果 206例CRII患者手术治疗229次,其中手术≥2次者31例.手术原因为肠梗阻142例次、肠瘘56例次、直肠炎12例次、出血6例次及其他手术13例次.229例次手术包括:病变肠切除+Ⅰ期肠吻合术142例,病变肠切除+肠造口术57例,病变肠袢旷置术14例,其他手术16例.术后肠道相关并发症53例(25.7％),术后28 d内病死率2.4％( 5/206).结论 合并肠梗阻、瘘、出血、穿孔等并发症的CRII需要外科治疗,选择合适的患者可以成功地实施病变肠切除Ⅰ期吻合,合理地应用肠造口术能够降低并发症及病死率.     

纵隔血管淋巴管瘤的诊断和外科治疗

目的 总结原发性纵隔血管瘤及淋巴管瘤的诊断和外科治疗.方法 收集解放军总医院1998年1月至2009年1月问收治的原发性纵隔血管瘤及淋巴管瘤患者的病历资料,提取相关临床数据,对其进行回顾性分析.结果 全组共11例患者,男7例、女4例,年龄4～78岁,平均38.9岁.6例无自觉症状,多数患者术前未能获得准确诊断.全组患者均接受手术治疗,手术完全切除10例,大部分切除1例,发生术后并发症2例.标本均经病理证实,5例血管瘤,3例淋巴管瘤,3例血管淋巴管瘤.结论 本病一经诊断应该尽早手术治疗,手术应尽可能彻底切除以防止复发.

Abstract：

Objective To review the experience of diagnosis and surgical treatment of the primary mediastinal hemangioma and lymphangioma.Methods We summarized the medical records of patients with primary mediastinal hemangioma or lymphangioma at our hospital from January 1998 to January 2009,then extracted relevant clinical data and carried out the retrospective analysis.Results There were 11 patients in the whole group.The age range was 4-78 years old(average:38.9).Six patients were symptom-free and most patients had not an accurate preoperative diagnosis.All patients underwent surgical procedures.The radical excision wag accomplished in 10 cases and incomplete excision in 1 case.Two cases of surgically related complications were observed.All the cases were diagnosed by postoperative histopathological examination.There were hemangioma(n=5),lymphangioma(n=3)and hematolymphangioma(n=3).Conclusions The operation should be performed once the diagnosis of hemangioma or lymphangioma is made.Radical excision should be performed to prevent a post-operative recurrence.     

Orbital and para-orbital tumours--a 10 years retrospective study

A total number of 631 cases of orbital and para-orbital tumours causing proptosis was analysed in a retrospective way in relation to age, anatomic location, histological and clinical profile. CT-scan was considered as the primary modality of investigation as it correctly delineates the extent of the tumour, integrity of bony structures and intracranial spread. Different modalities of surgery like lateral orbitotomy, medial orbitotomy, lateral rhinotomy and endoscopic excision, etc, had been performed depending upon the anatomical locations. Surgical approaches, histological types of various tumours are analysed in detail.     

368例发热原因待查患者诊断分析

目的 分析以"发热原因待查"收入感染科患者的病因构成、诊断方法,总结临床诊断思路,为诊断发热患者提供科学的临床思维方法.方法 回顾性分析2002年1月至2009年12月由门诊初诊为"发热原因待查"收住解放军第三○二医院的368例患者的最终病因诊断,诊断手段以及其病因与性别、年龄及热程之间的关系.结果 368例患者中11...