儿童球结膜下迷芽瘤34例手术治疗分析

目的 探讨儿童球结膜下迷瘤的临床、病理及CT特点和手术治疗.方法 回顾性分析经手术治疗及病理证实的儿童球结膜下迷芽瘤34例.结果 34例中男17例、女17例,均为单发.发现肿块的平均年龄3个月(年龄范围8d至2岁);就诊平均年龄2岁6个月(年龄范围2月至12岁).均因发现球结膜下包块就诊.瘤体位于颞侧33例、鼻侧1例.多位于近外眦部球结膜下,与球结膜粘连,与眼球筋膜无粘连,与眶内脂肪相连.术前19例行眼眶CT横断面扫描,CT上病灶表现为附着于眼环颞侧的新月形低密度影,CT值-53～-106HU.外缘结膜下均有1～2mm厚的囊壁.6例行增强扫描,增强后囊壁均中度强化.病理分类皮脂瘤29例,异位泪腺1例,异位唾液腺2例,皮脂瘤伴异位唾液腺1例,骨瘤1例.无自然消退现象.术后1例复发,1例睑球粘连,1例哭无泪,1例干眼症并丝状角膜炎,无其他并发症发生.结论 儿童球结膜下迷芽瘤是一种少见的先天性良性肿瘤,多为皮脂瘤.皮脂瘤的临床特征为结膜下缓慢生长软性的淡黄色扁平隆起,瘤组织南脂肪及纤维构成.CT检查可显示病灶的大小、范嗣、性质,以及与眼环、外直肌、泪腺等的关系,有助于提高手术成功率,减少并发症.最佳治疗是手术切除.

A study on 34 cases' operation to treat subconjunctival choristoma in children

Objective To review the clinical and histopathologie features and discuss the guidelines for surgical management of subconjunctival choristoma in children.Methods A retrospective study of 34 patients with subconjunctival choristoma who underwent surgical excision was reviewed.Results Of 34 patients,there were 17 males and 17 females.All patients had solitary lesions.Mean age when choristoma was discovered was 3 months old(range from 8day to 2years).Mean age at the time of diagnosis was 2.6years (range from 2months to 12 years).The presenting symptom was a subconjunctival mass in all 34 patients.The tumor occurred on temporal quadrant in 33 cases,on nasal quadrant in 1 case,almost of them were near lateral canthus.The mass was tightly adhered to bulbar eonjunctiva but not fixed to the under fascia.The mass was continuous with orbital fat.Transverse plain CT scan was performed in 19 patients,ereseent-shaped hypodensity lesion attached to the epibulbar was detected in all cases on CT scan,CT density was-53 to-106HU,contrast enhanced CT scan in 6 cases.The lesion had a thin wall(1-2mm)under the conjunctiva lateral and could have middle enhancement.In pathology,there were 29 dermolipomas,1 dystopia lacrimal gland,2 heterotopic salivary glands,1 dermolipoma with heterotopic salivary glands,1 osteoearcinoma.Spontaneous regression was never observed,after surgery,1 recurrence,1 atretoblepharia,1 alacrimia,1 xeroma with keratitis filamentosa were observed in 34 patients.Conclusions Children subconjuetive ehoristoma is a rare congenital benign tumor.Most of them are dermolipomas.The clinical feature is a soft,amber flat,slowly-growing,subconjunetival tumor.The histopathologle features show two characteristic constructions,the fat and fiber.CT scan shows the lesion's range and characteristics as well as the relationship with the adjacent structures.CT scan has great directive value for operating on these tumors and reducing the complications.The best treatment is surgical excision.