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.

Transconjunctival approach for orbital cavernous hemangiomas, a report of 39 cases

Objective:To evaluate the efficacy of transconjunctival approach for patients with orbital cavernous hemangiomas, and to understand its relationship with imaging localization. Methods: We retrospectively studied the clinical data of 39 patients with orbital cavernous hemangioma who were treated with transconjunctival orbitotomy. The clinical and radiologic characteristics of orbital cavernous hemangiomas, the surgical outcomes, and the selection criteria were analyzed. Results: We noticed that all the cavernous hemangiomas in this study were just behind the globe or compressing the globe. CT and MRI showed that all the 39 hemangiomas were located in the muscle cone, round in shape and with well-defined margins. The hemangiomas of 36 patients, which showed slight adhesion and no large draining vein by image examination, were completely resected. One patient with large draining vein was also extirpated completely, but only with visual loss. In the other 2 patients with tight adhesion, most fragments of tumors were removed. The successful rate of operation was 92.3%. The visual acuity increased in 6 of 9 cases with primary visual impairment. All the 32 patients with primary proptosis had their symptoms resolved completely. The treatment outcomes were obvious in 32 (82.1%) patients, remained unchanged in 5 (12.8%) patients, and worsened in 2(5.1%) patients. Conclusion: Retrobulbar intraconal cavernous hemangiomas can be removed successfully through a transconjunctival approach. However, other approaches must be recommended if the tumor is closely attached to the orbital apex, adheres tightly to the retrobulbar tissues, or with large draining veins.