141例泪腺占位性病变临床分析

目的：探讨141例泪腺占位性病变患者的病理类型和临床特点。方法：回顾性系列病例研究。选取2019年6月至2021年10月在吉林大学第二医院眼科中心诊治的141例泪腺区占位病变患者的临床资料，包括患者性别、年龄、临床表现、影像学特点及组织病理结果。依据病理诊断分类，探讨泪腺占位性病变的临床和影像学特点。组间比较采用独立样本t检验或非参数秩和检验；分类变量以例数、百分比表示，组间比较采用卡方检验和（或）Fisher确切概率法。结果：纳入患者中，男50例，女91例。按病变性质分类，良性病变117例（83.0%），最常见的是IgG4相关泪腺炎55例（39.0%）；恶性肿瘤24例（17.0%），最常见的是淋巴瘤10例。良性病变患者年龄（ 45.8±15.7）岁]小于恶性肿瘤（ 56.3±16.2） 岁]，差异有统计学意义（Z=-3.23, P=0.001）。按病变类型依次为炎性病变72例（51.1%），上皮性病变33例（23.4%），淋巴系统病变17例（12.1%）。比较泪腺上皮性病变、炎性病变、淋巴系统病变3组患者性别构成、临床表现（眼睑肿胀、眼球突出、运动障碍、视力下降）、影像学表现（双侧泪腺受累、眶骨质改变、鼻窦炎），差异均有统计学意义（均P<0.05）；3组在眼痛、眼外肌和三叉神经增粗，差异 无统计学意义。两两相比显示，泪腺上皮性病变较泪腺炎性病变的女性患者比例少，出现眼睑肿胀、泪腺双侧受累、鼻窦炎的患者比例少（χ2=17.01，P<0.001；χ2=32.34,P<0.001；χ2=10.43，P=0.001； χ2=10.12，P=0.001），而有眼球突出、运动障碍和视力下降、骨质破坏的患者比例较高（χ2=18.71，P<0.001；χ2=7.64，P=0.006；χ2=7.32，P=0.012）；泪腺上皮性病变患者与淋巴系统病变相比，前者出现眼睑肿胀、双侧泪腺受累的患者比例低，眼球突出的患者比例较高，差异有统计学意义（χ2=15.93，P<0.001；χ2=6.38，P=0.012；χ2=10.14，P=0.001）；泪腺炎性病变与淋巴系统病变性仅在泪腺双侧受累比例差异有统计学意义(χ2=10.43，P=0.001）；淋巴系统病变与炎性及上皮性病变相比，其余各组间临床和影像学的表现差异无统计学意义。儿童泪腺占位性病变7例中未见上皮性病变。结论：泪腺占位性病变中最常见的是炎性病变，其次是上皮性病变；良性病变平均年龄小于恶性肿瘤；儿童泪腺病变类型分布与成人不同；泪腺炎性病变与上皮性病变的临床和影像学表现差异较大，相对容易鉴别。

Clinical Analysis of 141 Cases of Occupying Lesion of Lacrimal Gland

Objective: To investigate the clinicopathologic features of 141 patients suffering from sustained lacrimal gland occupying lesions. Methods: Retrospective series of case studies. The clinical data of 141 patients having sustained lacrimal gland occupying lesions from June 2019 to October 2021 in the Second Hospital of Jilin University were selected, including gender, age, clinical manifestations, imaging examinationand histopathological diagnosis. The clinical and imaging features of lacrimal gland lesions were delved into as per the classification of pathological diagnosis. An independent sample t-test or nonparametric rank-sum test was used for comparison between groups. The classification variables were expressed in terms of case number and percentage, and the Chi-square test and/or Fisher exact probability method were used for comparison between groups. Result: 141 patients, including 50 males and 91 females,were recruited. According to the nature of lesions, 117 cases (83.0%) were benign lesions, and the most common disease was found to be IgG4-related dacryoadenitis, 55 cases. 24 cases (17.0%) were malignant tumours, and the most common disease was lymphoma accounting for 10 cases. The average age of benign lesions (45.8±15.7 years) is younger than that of malignant lesions (56.3±16.2 years) and the difference was statistically significant (Z=-3.23, P=0.001). According to the frequency, there were 72 cases of inflammatory diseases (51.1%), 33 cases of epithelial diseases (23.4%) and 17 cases of lymphatic system diseases (12.1%). Lacrimal occupying lesions were divided into three groups: dacryoadenitis,lymphoproliferative and epithelial tumours. Besides, among the three groups, the gender ratio, clinical manifestations (eyelid swelling, proptosis, limited ocular motility and decreased vision), imaging manifestations (bilateral involvement, orbital bone changes, rhinosinusitis), all of these results possessed statistical significance (P<0.05). However, there was no significant difference in ocular pain, thickened extraocular muscle and enlarged trigeminal nerve among the three groups. Pairwise comparisons were between groups, epithelial tumors compared to dacryoadenitis, the former has affected a lower proportion of females, eyelid swelling, bilateral involvement and rhinosinusitis(χ2=17.01, P<0.001; χ2=32.34, P<0.001; χ2=10.43, P=0.001; χ2=10.12, P=0.001), a higher proportion of proptosis, limited ocular motility, decreased vision and bone destruction were statistically significant (χ2=18.71, P<0.001; χ2=7.64, P=0.006; χ2=7.32, P=0.012); Additionally, epithelial tumours were compared to lymphoproliferative lesions, and it was found that the former has a lower proportion of eyelid swelling and bilateral involvement, but a higher proportion of proptosis, with a statistically significant difference (χ2=15.93, P<0.001; χ2=6.38,P=0.012;χ2=10.14, P=0.001); The difference was statistically significant only in bilateral involvement between the dacryoadenitis and lymphoproliferative lesions groups(χ2=10.43, P=0.001). Besides, there was nosignificant difference in the remaining clinical and imaging manifestations of lymphoproliferative lesions compared with dacryoadenitis and epithelial tumours. No epithelial tumours were found in 7 children with lacrimal gland space occupying lesions. Conclusion: Inflammatory diseases are the most common occupying lesions of the lacrimal gland, followed by epithelial tumours. The average age of benign lesions is less than that of malignant lesions. The distribution of lacrimal gland lesions in children differs from those in adults. The clinical and imaging manifestations of lacrimal gland dacryoadenitis and epithelial tumours contain conspicuous differences which are readily distinguishable.