四种手术入路对眼眶深部海绵状血管瘤患者的影响
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摘要
目的:探讨经结膜入路、外侧入路、皮肤入路及外侧联合内侧结膜入路对眼眶深部海绵状血管瘤患者视力、肿瘤残余率及并发症的影响。方法:眼眶深部海绵状血管瘤患者114例,根据手术入路分为A组(30例,经结膜入路)、B组(34例,经外侧入路)、C组(27例,经皮肤入路)及D组(23例,经外侧联合内侧结膜入路),比较四组患者视力改善效果、肿瘤残余率及术后并发症。结果:四组患者视力改善效果无差异(P=0.918)。A组、B组、C组及D组患者术后肿瘤残余率分别为0、2.9%、3.7%、0(P>0.05)。四组患者术后并发症发生率无差异(P=0.244)。结论:根据眼眶深部海绵状血管瘤适应证,合理选择微创手术入路均可有效维持正常视力水平,且安全性均一致。
AIM: To investigate the effects of conjunctival approach, lateral approach, skin approach and lateral medial conjunctival approach on visual acuity, tumor residual rate and complications in patients with deep cavernous hemangioma of the orbit.METHODS: Totally 114 patients with deep cavernous hemangioma of the orbit were divided into group A(30 cases, conjunctival approach), group B(34 cases, translateral approach) and group C(27 cases, transcutaneous) according to the surgical approach. The approach and the D group(23 cases, combined with the medial conjunctival approach via the lateral side), compared the visual acuity improvement effect, tumor residual rate and postoperative complications in the four groups.RESULTS: There was no difference in visual acuity improvement between the four groups(P=0.918). The residual tumor rates of patients in group A, group B, group C and group D were 0, 2.9%, 3.7%, and 0, respectively. There was no difference in the incidence of postoperative complications between the four groups(P=0.244). CONCLUSION: According to the indications of deep cavernous hemangioma of the orbit, the reasonable choice of minimally invasive surgery can effectively maintain the normal visual acuity level and the safety is consistent.
AIM: To investigate the effects of conjunctival approach, lateral approach, skin approach and lateral medial conjunctival approach on visual acuity, tumor residual rate and complications in patients with deep cavernous hemangioma of the orbit.METHODS: Totally 114 patients with deep cavernous hemangioma of the orbit were divided into group A(30 cases, conjunctival approach), group B(34 cases, translateral approach) and group C(27 cases, transcutaneous) according to the surgical approach. The approach and the D group(23 cases, combined with the medial conjunctival approach via the lateral side), compared the visual acuity improvement effect, tumor residual rate and postoperative complications in the four groups.RESULTS: There was no difference in visual acuity improvement between the four groups(P=0.918). The residual tumor rates of patients in group A, group B, group C and group D were 0, 2.9%, 3.7%, and 0, respectively. There was no difference in the incidence of postoperative complications between the four groups(P=0.244). CONCLUSION: According to the indications of deep cavernous hemangioma of the orbit, the reasonable choice of minimally invasive surgery can effectively maintain the normal visual acuity level and the safety is consistent.
引文
1 Young SM, Kim YD,Lee JH, et al. Radiological Analysis of Orbital Cavernous Hemangiomas: A Review and Comparison Between Computed Tomography and Magnetic Resonance Imaging. J Craniofac Surg 2018;29(3):712-716
2 Kang X,Min W,Jiang Q. Visual function alterations in cavernous hemangioma of the orbital apex after surgery. Int J Ophthalmol 2016;9(10):1528-1531
3 Baki A. Nasal Septal Cavernous Hemangioma. J Craniofac Surg 2018;29(2):e135-e136
4 Kloos R,Mourits D,Saeed P, et al. Orbital apex cavernous hemangioma-beware of the pear. Acta Ophthalmol 2013;91(4):e328-e329
5程金伟,魏锐利,蔡季平,等. 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). 第二军医大学学报2007;28(2):193-195
6青格勒图,李琳,新吉夫,等. 不同手术入路治疗眼眶肿瘤的疗效分析. 国际眼科杂志2018;18(6):174-176
7李凤鸣,谢立信. 中华眼科学. 北京:人民卫生出版社2014:321-322
8高占国. 眼眶病临床实践与思考. 北京:人民卫生出版社2014:102-103
9刘东,李彦和,张志远,等. 伽玛刀放射外科治疗眼眶海绵状血管瘤. 中国微侵袭神经外科杂志2018;22(1):30-32
10 Wang X,Yan J. Concomitant Multiple Cavernous Hemangiomas and Venous Angioma of the Orbit. J Craniofac Surg 2014;25(4):356-358
11青格勒图,李琳,新吉夫,等. 不同手术入路治疗眼眶肿瘤的疗效分析. 国际眼科杂志 2018;18(6):1139-1141
12 Aymard PA,Langlois B,Putterman M, et al. Management of orbital cavernous hemangioma-evaluation of surgical approaches: report of 43 cases. J Fr Ophtalmol 2013;36(10):820-829
13 Wu W,Selva D,Jiang F, et al. Endoscopic transethmoidal approach with or without medial rectus detachment for orbital apical cavernous hemangiomas. Am J Ophthalmol 2013;156(3):593-599
14钟一凡,张瑞君,李佳,等. 结膜入路联合指法分离技术摘除眼眶肌锥内海绵状血管瘤. 中国美容整形外科杂志2017;28(6):368-370,377
15 Antonov NK,Spenceshishido A,Marathe KS, et al. Orbital Hemangioma with Intracranial Vascular Anomalies and Hemangiomas:A New Presentation of PHACE Syndrome? Pediat Dermatol 2016;32(6):e267-e272
16 Calandriello L,Grimaldi G,Petrone G, et al. Cavernous venous malformation (cavernous hemangioma) of the orbit: current concepts and a review of the literature. Surv Ophthalmol 2017;62(4):393-403
2 Kang X,Min W,Jiang Q. Visual function alterations in cavernous hemangioma of the orbital apex after surgery. Int J Ophthalmol 2016;9(10):1528-1531
3 Baki A. Nasal Septal Cavernous Hemangioma. J Craniofac Surg 2018;29(2):e135-e136
4 Kloos R,Mourits D,Saeed P, et al. Orbital apex cavernous hemangioma-beware of the pear. Acta Ophthalmol 2013;91(4):e328-e329
5程金伟,魏锐利,蔡季平,等. 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). 第二军医大学学报2007;28(2):193-195
6青格勒图,李琳,新吉夫,等. 不同手术入路治疗眼眶肿瘤的疗效分析. 国际眼科杂志2018;18(6):174-176
7李凤鸣,谢立信. 中华眼科学. 北京:人民卫生出版社2014:321-322
8高占国. 眼眶病临床实践与思考. 北京:人民卫生出版社2014:102-103
9刘东,李彦和,张志远,等. 伽玛刀放射外科治疗眼眶海绵状血管瘤. 中国微侵袭神经外科杂志2018;22(1):30-32
10 Wang X,Yan J. Concomitant Multiple Cavernous Hemangiomas and Venous Angioma of the Orbit. J Craniofac Surg 2014;25(4):356-358
11青格勒图,李琳,新吉夫,等. 不同手术入路治疗眼眶肿瘤的疗效分析. 国际眼科杂志 2018;18(6):1139-1141
12 Aymard PA,Langlois B,Putterman M, et al. Management of orbital cavernous hemangioma-evaluation of surgical approaches: report of 43 cases. J Fr Ophtalmol 2013;36(10):820-829
13 Wu W,Selva D,Jiang F, et al. Endoscopic transethmoidal approach with or without medial rectus detachment for orbital apical cavernous hemangiomas. Am J Ophthalmol 2013;156(3):593-599
14钟一凡,张瑞君,李佳,等. 结膜入路联合指法分离技术摘除眼眶肌锥内海绵状血管瘤. 中国美容整形外科杂志2017;28(6):368-370,377
15 Antonov NK,Spenceshishido A,Marathe KS, et al. Orbital Hemangioma with Intracranial Vascular Anomalies and Hemangiomas:A New Presentation of PHACE Syndrome? Pediat Dermatol 2016;32(6):e267-e272
16 Calandriello L,Grimaldi G,Petrone G, et al. Cavernous venous malformation (cavernous hemangioma) of the orbit: current concepts and a review of the literature. Surv Ophthalmol 2017;62(4):393-403