带血管蒂颞顶筋膜瓣移植进行眶腔重建

目的分析带血管蒂颞顶筋膜瓣转移进行眶腔重建的优缺点和适应证。方法对行眶内容摘除术后的19例患者,利用同侧颞浅动脉、静脉作为供养血管,通过皮下组织隧道将组织块移植到眶内重建眶窝,进行同期或延期带血管蒂颞顶筋膜瓣转移实施眼眶重建。结果随访观察16例,随访时间为6～120个月,平均55个月。3例局部复发,向副鼻窦蔓延;4例死于全身转移,但眼部情况基本正常;余9例正常,其中5例患者眶腔重建后出现眼睑畸形、位置异常,二期进行眼睑整形,结膜囊扩大和增加眶腔体积等手术后,外观均明显改善。3例患者失访。结论利用带血管蒂颞顶筋膜瓣转移进行眼眶重建,不需吻合血管,操作较简单,易于成活,术后外观满意,是较好的重建方法,但不能防止肿瘤复发。

Orbital reconstruction by temporoparietal fascia with vascular pedicle

Objective The aim of this work was to establish a surgery way for the cosmetic improvement after orbital exoneration and evaluate the clinical value and the indication of orbital reconstruction by temporoparietal fascia with vascular pedicle.Methods Nineteen cases received orbital reconstruction were analyzed retrospectively and 16 cases of them were follow-up for 6-120 months,including the adenoid cystic carcinoma of the lacrimal gland,rhabdomyosarcoma,melanoma of conjunctiva,liposarcoma,orbital invasion by retinablastoma,neurobiastoma etc..Orbital reconstruction was performed under general anesthesia at synchronization or postpone of orbital exenteration,and temporoparietal fascia with vascular pedicle was transplanted into the orbital cavity.The second stage of plasty was performed in 5 cases of orbital reconstruction for eyelid abnormity,conjunctival sac diminution and portion absorption of orbital content.Results Sixteen cases of 19 cases were followed-up for 6-120 months and 3 patients lost.Nine patients of them were normal after operation and every pore was at medical imaging examination.Three patients presented reoccurrence of tumor at local and extended toward paranasal sinus.Four patients died from metastasis,but showed a normal manifestation in reconstructive orbit.After the second stage of plasty,patients got better cosmetically acceptable appearance.Conclusion Orbital reconstruction using temporoparietal fascia with vascular pedicle is a better method for ocular tumor,because it does not need to anastomose vessel,present a simple operation procedure and has good blood supply to tissue.This method is applicable in the patients removed whole orbital tumor and observed over 3 years after synthesis treatment of orbital tumors.But it does not prevent the recrudescence of orbital tumor.