發(fā)布時間：2018-06-23 16:46

  本文選題：眼眶神經鞘瘤 + 臨床表現��； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的眼眶神經鞘瘤絕大多數為良性腫瘤,患者以眼球突出、視力下降、眼動障礙或復視等就診,眶內腫瘤常引起眼部這些改變,與眶內其他腫瘤不易鑒別。腫瘤生長位置變化較大,瘤外包膜菲薄,術中囊膜破裂腫瘤殘留往往是導致腫瘤術后復發(fā)的主要原因。本文研究目的主要是通過臨床和影像學分析做出腫瘤組織學判斷,根據腫瘤位置和范圍制定最佳手術方案,取得最佳預后。方法收集天津醫(yī)科大學第二醫(yī)院眼科1985年至2014年間經病理組織學確診的眼眶神經鞘瘤226例,通過分析這些病例的臨床表現、影像學特征以及查閱相關文獻以分析、總結該病的臨床特點,提高術前診斷正確率�？偨Y本文病例資料以及借鑒國內外關于本病的治療經驗,探討該病的最佳治療方法。結果1、臨床表現:患者多以漸進性眼球突出就診,典型臨床表現為眼球突出、視力下降、捫及腫物以及眼球運動障礙。2、影像學檢查結果:B型超聲檢查(B mode ulthasonography)腫瘤內回聲多不均勻,占57.00%,多為實體回聲顯示大小不等無回聲區(qū)。彩色多普勒(color Doppler imaging,CDI)檢查顯示腫瘤血流分布多樣。CT(computed tomography,CT)檢查顯示腫瘤分布位置廣泛,以上方及外側居多,常累及眼眶后1/3段。形狀多樣,主要為長條形及類圓形。磁共振成像(magnetic resonance imaging,MRI)檢查顯示腫瘤內部信號豐富,特別是T2WI像,以低、中、高混雜信號為主。3、術式選擇:前路開眶術、外側開眶術、內側開眶術、內外聯合開眶術、眶內容切除術以及經顱開眶術分別為89例、110例,5例、9例、5例、4例。行外側開眶術者較前路開眶術者并發(fā)上瞼下垂、視力下降、眼動受限風險大。累及眶后1/3段行前路開眶術較外側開眶術腫瘤易殘余,未累及者則無差異。4.良惡性鑒別及處理原則:當發(fā)現腫瘤生長較快,疼痛感明顯,眼眶骨壁有破壞時,應高度懷疑惡性病變。良性腫瘤未累及眶后1/3段多采用前路開眶術,累及眶后1/3段腫瘤多采用外側開眶術。惡性腫瘤需行腫瘤擴大切除術或眶內容摘除術,術后輔助放射治療。惡性者較良性易復發(fā)。結論大多數眼眶神經鞘瘤可通過影像學檢查確定術前組織學判斷。B型超聲顯示腫瘤內部回聲少且不均勻,實體腫瘤內顯示數個小片狀或融合成片透聲區(qū),應高度懷疑為眼眶神經鞘瘤。CT顯示腫瘤呈串珠狀或葫蘆狀生長,或呈與眼軸平行長條形或長錐形生長時,多為眼眶神經鞘瘤,結合經眶上裂向顱內海綿竇區(qū)蔓延基本可以肯定診斷。啞鈴形生長眶顱溝通腫瘤,啞鈴形中間部在眶上裂處,兩端分別在眶內和海綿竇區(qū),眶頂骨質不增厚或缺失,亦應高度懷疑神經鞘瘤可能。MRI顯示腫瘤T2WI呈低、中、高混雜信號,結合腫瘤特殊形狀,如串珠狀、長條形、啞鈴形等,多數可以肯定為眼眶神經鞘瘤。未及眶后1/3段腫瘤、粘連不嚴重者多行前路開眶術,累及眶后1/3段粘連嚴重者可選擇外側開眶術,若位置靠近內側、體積較大,可聯合內側開眶術�？麸B溝通者開眶取出苦難者可考慮經顱開眶。良性腫瘤多選擇腫瘤局部切除術,惡性腫瘤需行腫瘤擴大切除術或眶內容切除術。
[Abstract]:Objective orbital neurilemmoma is the most benign tumor. The patients are treated with exophthalmos, visual impairment, eye movement disorder or diplopia. Orbital tumors often cause these changes, which are difficult to identify with other orbital tumors. The location of tumor growth is larger, the outer capsule is thin, and the residual membrane ruptured tumor in the operation often leads to the postoperative tumor operation. The main cause of recurrence is the main purpose of this study. The purpose of this study was to make the tumor histological judgement through clinical and imaging analysis, to make the best surgical procedure according to the location and scope of the tumor, and to obtain the best prognosis. Methods 226 cases of orbital neurilemmoma diagnosed by pathological histology from 1985 to 2014 of Second Hospital Affiliated to Tianjin Medical University were collected. By analyzing the clinical manifestations of these cases, imaging features and consulting related literature, the clinical characteristics of the disease were summarized, the correct rate of preoperative diagnosis was improved, the case data and the experience of treating the disease at home and abroad were summarized, and the best treatment methods were discussed. Results 1, clinical manifestation: the patients were mostly progressive eyes. The typical clinical manifestations were the protrusion of the eyeball, the decline of eyesight, the palpability of the tumor and the.2 of the eye movement disorder. The results of imaging examination: the internal echo of the B mode ulthasonography (B mode ulthasonography) was mostly uneven, accounting for 57% of the solid echo, and the color Doppler (color Doppler imaging, CDI) examination. The multiple.CT (computed tomography, CT) examination showed that the tumor was widely distributed in the upper and lateral areas and often involved the 1/3 segment of the orbit. The shape of the tumor was varied, mainly in the strip and round. The magnetic resonance imaging (magnetic resonance imaging, MRI) examination showed that the tumor was rich in the internal signal, especially the T2WI, low, middle. .3 with high mixed signal, surgical choice: anterior orbit, lateral orbit, medial orbit, internal and external orbit, orbital content resection and transcranial orbit, 89 cases, 110 cases, 5 cases, 9 cases, 5 cases, 4 cases. There is no difference between the 3 segment of the anterior orbit operation and the lateral orbitorma tumor. There is no difference in the differential diagnosis and treatment of.4.. When the tumor grows faster, the pain is obvious, and the orbital bone wall is damaged, the malignant lesions should be highly suspected. The benign tumor does not involve the 1/3 segment of the orbit, and the 1/3 segment of the orbit is multiple. Use of lateral orbitorma. Malignant tumors require enlarged tumor resection or orbital extirpation, postoperative adjuvant radiotherapy. Malignant ones are more benign and easy to relapse. Conclusion most orbital neurinomas can be determined by imaging examination to determine the preoperative histologic judgement of.B ultrasound showing that the internal echo of the tumor is less and unevenly, and there are several small signs in solid tumors. It is highly suspected that the.CT of the orbital neurilemmoma should be highly suspected as that the orbital neurilemmoma is a bead shaped or gourd like growth, or when it grows parallel to the axis of the eye axis or long conical growth, it is mostly orbital neurilemmoma, and the diagnosis is basically confirmed by the spread of the orbital fissure to the intracranial cavernous sinus. The dumbbell shaped growth of the orbital cranium is a tumor, dumb. In the middle of the bell shaped part of the orbital fissure, both ends in the orbital and cavernous sinus regions, the orbital apex bone is not thickened or missing, and the possible.MRI of the schwannoma should be highly suspected that the tumor T2WI is low, medium and high mixed signals, combined with the special shape of the tumor, such as the bead like, long strip, dumbbell shape, and so on. Most of the tumor can be confirmed as the orbital neurilemmoma. No posterior 1/3 in the orbit. Patients with segment tumors and not serious adhesions have multiple anterior orbitofrontal surgery. The lateral orbit operation can be selected for those who are involved in the posterior 1/3 segment of the orbit. If the position is close to the inside, the volume is larger, the orbital operation can be combined with the medial orbit. The orbital craniac communicators can take the orbitofrontal orbitorts into the orbit. Excision or orbital excision.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.7

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