下眼睑大面积基底细胞癌的手术治疗及眼睑再造

目的：总结下眼睑大面积基底细胞癌的手术治疗和眼睑修复再造经验。方法：2003年7月-2008年7月，收治7例术前活检确诊为基底细胞癌，且肿瘤侵犯面积大于2／3眼睑，深度达到眼睑全层的患者。男3例，女4例；年龄56—79岁。用标准切除法切除肿瘤后，采用颧部带蒂皮瓣和硬腭粘膜分别作为再造眼睑的外层和内层，重建眼险。主要随访指标为眼睑形态、功能及肿瘤复发率与生存率。结果：术后患者皮瓣均成活，创面Ⅰ期愈合。供区均未形成继发性缺损，创面Ⅰ期愈合。7例患者随访6个月-5年，再造眼睑色泽、质地与周围皮肤匹配良好，除1例患者下眼睑轻度外翻致轻度闭合不全外，其余患者再造眼睑外形自然，功能良好。随访期肿瘤均无复发。结论：采用标准切除法切除肿瘤可以有效控制肿瘤的复发，颧部带蒂皮瓣移位联合硬腭粘膜移植可以较好地修复缺损眼睑并保持眼睑功能。

Surgical treatment and eyelid reconstruction for large lower eyelid basal carcinoma

Objective：To summarize surgical treatment of basal cell carcinoma involving lower eyelid widely and restoration of incomplete lower eyelid. Methods： Seven patients suffered from large lower eyelid basal cell carcinoma were included in this study. All patients got standard excision surgery to remove the tumor completely, and the defected lower eyelids were restored by pedicle skin flap from regio zygomatica and hard palatine mucosa,which were used to replace the outer and inner layer of lower eyelid respectively. The follow - up index included shape and function of lower eyelids, recurrence rate of tumor and survival rate of patients. Results ： All the patients had survived skin flap and good wound healing, without secondary deletion in the donor sites. One patient had mild ectropion and dysraphism, other patients＇ restored lower eyelids were matched normally with the nearby skin and showed normal shape and function. All the patients had no tumor recurrence during the 6 months -5 years followed up. Conclusion：Tumor recurrence can be controlled by standard excision surgery; the defected lower eyelid can be restored well by pedicle skin flap from regio zygomatica and hard palatine mucosa.