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目的探讨侵犯颅前、中窝的泪腺肿瘤的经颅眶入路手术方法及疗效。方法回顾性分析23例侵犯颅前、中窝的泪腺肿瘤的临床资料。23例中男15例,女8例,年龄2~76岁,平均42·5岁。病史2个月~27年,平均43个月。主要临床表现为眼球突出、局部疼痛。对所有病人均经颅眶入路进行手术切除肿瘤治疗。23例病人中腺样囊性癌11例,恶性混合瘤6例,泪腺腺癌2例,鳞癌1例,导管癌1例,肌上皮癌1例,良性混合瘤1例。对18例病人进行术后随访,时间为1个月至7年,平均35个月。结果术后4例病人上睑下垂;1例术后眼球固定、视力丧失。无手术死亡及其他手术并发症病人。随访结果:4例病人肿瘤复发,死于泪腺腺癌全身转移1例。结论泪腺恶性肿瘤,以腺样囊性癌最多见,易破坏颅骨,侵犯颅前、中窝,经颅眶入路可获得充分的眶尖减压和肿瘤显露。但肿瘤难以全切,容易复发,术后需放、化疗,预后不良。
Objective To investigate the transcranial orbital approach and its efficacy in infracting the lacrimal gland tumors in the anterior and middle fossa. Methods The clinical data of 23 cases of lacrimal gland tumor invading the anterior skull and middle fossa were retrospectively analyzed. Among the 23 cases, 15 were males and 8 were females, ranging in age from 2 to 76 years with an average of 42.5 years. History of 2 months to 27 years, an average of 43 months. The main clinical manifestations of prominent eye, local pain. All patients underwent transcranial orbital surgical resection of the tumor. 23 cases of adenoid cystic carcinoma in 11 cases, 6 cases of malignant mixed tumor, 2 cases of lacrimal gland adenocarcinoma, squamous cell carcinoma in 1 case, ductal carcinoma in 1 case, myoepithelial carcinoma in 1 case, benign mixed tumor in 1 case. 18 patients were followed up for a period of 1 month to 7 years, an average of 35 months. Results 4 cases of patients with ptosis after surgery; 1 case of fixation of the eye, loss of vision. No surgical death and other surgical complications of patients. Follow-up results: 4 patients with tumor recurrence, died of lacrimal gland adenocarcinoma in 1 case of systemic metastasis. Conclusion Malignant neoplasms of lacrimal gland are the most common forms of adenoid cystic carcinoma, which are easy to destroy the skull and infrate the anterior cranial fossa, middle fossa and transcranial orbital approach to obtain sufficient orbital apex decompression and tumor exposure. But the tumor is difficult to cut, easy to relapse, postoperative need to put, chemotherapy, poor prognosis.