摘要
目的回顾性分析眼睑恶性肿瘤的临床、病理学分类以及行Mohs法切除后进行眼睑缺损修复的方法及效果。方法对近10年来收治的95例（95只眼）眼睑恶性肿瘤进行回顾性分析，其中上睑54例，下睑41例，其中男性46人，女性49人，平均年龄（61．2＋16．8）岁（47岁．87岁）。所有患者行Mohs法切除后，根据眼睑缺损范围和部位采用不同方法进行眼睑成形或再造。其中66例患者眼睑后层缺损达全长30％-50％，行外眦切开直接缝合；19例患者眼睑后层缺损超过全长50％，分别采用睑板结膜瓣滑行修复、异体巩膜移植修复。采用皮瓣或游离皮片修复眼睑前层缺损；9例患者为眼睑前层缺损，行邻近带蒂皮瓣或游离皮片修补；1例患者眼睑缺损较大仅行带蒂皮瓣转移修复，二期行眼睑再造。结果95例患者的病理诊断分别为基底细胞癌43例、睑板腺癌30例、鳞状上皮细胞癌16例、恶性黑色素瘤6例。94例患者手术后眼睑完整，形态及功能基本恢复正常；有1例基底细胞癌患者因肿瘤侵及范围较大，术后眼睑畸形明显，6个月后行二期眼睑再造，回复了眼睑基本功能，效果较为满意。所有患者随访10～30个月，有2例患者肿瘤局部复发，无全身转移，经再次手术后均未再复发。结论眼睑恶性肿瘤多发生于中老年人，其中以基底细胞癌最常见，其次为睑板腺癌和鳞状上皮细胞癌。治疗方法多采取Mohs法切除肿瘤后联合Ⅰ期眼睑缺损修复，达到眼睑形态和功能的恢复。
Objective To analyze the clinical characteristics, histopathological classification, the treatment methods and eyelids reconstruction methods of the patients with malignant eyelid tumors. Methods Ninety-five cases （95 eyes） of eyelid malignant tumors with histopathological diagnosis were retrospectively analyzed, 46 cases were male and 49 cases were female. The mean onset age of the patients was 61.2~16.8 years old （47-87 years old）. The incidence of upper lid was 54 eyes, lower lid was 41 eyes. All the patients were received the Mohs surgery by frozen section-guided excision and the first-phase eyelid reconstruction. The operations .of eyelid reconstruction were deepened on the position and content of eyelid defect. The whole-layer defect of eyelid in 66 cases of patients between 30%-50% was received the external canthus excised and sutured; the front-layer defect of eyelid in 9 cases of patients were received the operation {vith gauntlet skin flap or free skin flap; the whole-layer defect of eyelid beyond 50% in 19 cases of patients were received the tarsus-conjunctive flip reconstruction; the front-layer eyelid defect was repaired with skating skin flap or gauntlet skin flap, the front-layer defect of eyelid was repaired with free eye flap. A patient with basal cell carcinoma had a large defect was received the second-phase reconstruction. Results The histopathological diagnosis of 95 cases of patients was basal cell carcinomas （43 cases）, meibomian gland carcinomas （30 cases）, squamous cell carcinomas （16 cases）, and malignant melanoma （6 cases）. Of 94 cases of patients had satisfactory with eyelid contour and function. A patient with basal cell carcinoma had a wide invasion, the postoperative eyelid diperformance was significant, after the eyelid reconstruction in 6 months, the better appearance of eyelid was achieved. All the patients were follow-up for 10-30 months, 2 cases of patients were recurrent locally and none systemic metastasis, after the reoperation, the lesion was not recurrent. Conclusions Eyelid malignant tumor tends to affect the old patients. The leading malignant tumors are basal cell carcinomas, meibomian gland carcinomas and squamous cell carcinomas. Mobs sttrgery and eyelid reconstruction are the main choice of treatment. The eyelid reconstruction with tarsus-conjunctive flip is a simple and effective surgical method for better effect on its contour and fimction.
出处
《中国实用眼科杂志》
CSCD
北大核心
2012年第11期1367-1369,共3页
Chinese Journal of Practical Ophthalmology
