眼眶炎性假瘤的临床病理特征分析及治疗效果观察

目的　探讨淋巴细胞浸润型和硬化型眼眶炎性假瘤（ｏｒｂｉｔａｌｉｎｆｌａｍｍａｔｏｒｙｐｓｅｕｄｏ－ｔｕｍｏｒ，ＯＩＰ）的临床病理特征，以及手术切除联合皮质类固醇治疗硬化型ＯＩＰ的疗效。方法选择３２例淋巴细胞浸润型和５４例硬化型ＯＩＰ患者，检测血清中ＩｇＧ４的水平，组织病理分析ＩｇＧ４阳性细胞的表达情况。淋巴细胞浸润型ＯＩＰ患者采取糖皮质激素治疗，硬化型ＯＩＰ患者均进行手术切除联合低剂量糖皮质激素治疗。结果　硬化型患者血清ＩｇＧ４水平（１．８７±０．３８）ｇ?Ｌ－１明显高于淋巴细胞浸润型ＯＩＰ患者（０．９３±０．２１）ｇ?Ｌ－１，病理学检查结果显示淋巴细胞浸润型ＯＩＰ中有２例表现为浆细胞ＩｇＧ４阳性，硬化型ＯＩＰ患者中有２６例表现为浆细胞ＩｇＧ４表达阳性；淋巴检查细胞浸润型ＯＩＰ患者随访３ａ内有２例复发，硬化型ＯＩＰ患者经手术切除联合糖皮质激素治疗后，随访３ａ无一例复发。结论　在对ＯＩＰ患者进行诊治时，应首先根据临床症状和病理检查明确病变类型，对于硬化型ＯＩＰ患者应尽早行手术治疗，术后联合长期低剂量皮质类固醇治疗可明显改善硬化型ＯＩＰ患者的临床症状，提高治愈率。

Clinical pathologic analysis and therapeutic effects of orbital inflammatory pseudotumor

Objective To analyze the clinical pathologic features of constrictive orbital inflammatory pseudotumor ( OIP) and the synergetic effect of excision surgery and glucocorticoid for constrictive OIP. Methods A total of 32 cases of lymphocyte infiltrating OIP and 54 cases of constrictive OIP diagnosed by pathological examination were included in this study. The serum level of IgG4 and the IgG4 positive plasmocyte were examined. Lymphocyte infiltrating OIP patients received corticosteroids therapy, while the constrictive OIP patients received excision surgery and corticosteroids therapy. Results The serum IgG4 level ( 1. 87 +0. 38) g . L-l in constrictive OIP were significantly higher than lymphocyte infiltrating OIP ( 0. 93 + 0. 21 ) g . L -1 , histopathologic results showed that IgG4 in 26 cases of constrictive OIP were positive .while 2 cases of lymphocyte infiltrating OIP were positive. Two cases of lymphocyte infiltrating OIP recurred in 3 years , while no recurrence was found for constrictive OIP. Conclusion In the diagnosis and treatment of OIP , pathological examination is recommended for determining the pathological pattern , for the constrictive OIP , the synergetic treatment of excision surgery and corticosteroids can significantly improve the clinical symptoms and increase the recovery rate.