本文關(guān)鍵詞： 惡性腫瘤 瞼板腺癌 眼瞼缺損 成形術(shù) Mohs　出處：《河北醫(yī)科大學》2011年碩士論文　論文類型：學位論文

【摘要】：目的:瞼板腺癌是起源于瞼板,發(fā)生于眼瞼Meibomian腺(瞼板腺)的高度惡性、有致命危險的腫瘤,少數(shù)亦可發(fā)生于瞼緣的Zeis腺。腫瘤早期難以識別,一旦發(fā)現(xiàn),很難界定其范圍。因有跳躍性生長的特點而難以控制,早期診斷和廣泛切除是成功治療的關(guān)鍵。瞼板腺癌女性多見于男性,發(fā)病年齡大多在50~90歲。臨床診斷較為困難,需與霰粒腫、眼瞼結(jié)膜炎、結(jié)膜炎及基底底細胞癌相鑒別[1],易侵犯周圍組織,多經(jīng)淋巴、血液轉(zhuǎn)移[2]。瞼板腺癌的腺體特征不典型,故無明顯損害表現(xiàn)的眼臉腫物手術(shù)切除和病理檢查至關(guān)重要[3]。瞼板腺癌高發(fā)于老年人,常造成誤診。手術(shù)治療不徹底,導致眼眶內(nèi)破壞及轉(zhuǎn)移死亡。瞼板腺癌以手術(shù)治療為主,放射治療不敏感,只能作為輔助療法應(yīng)用。本研究探討了瞼板腺癌的臨床特點、診斷治療和瞼板腺癌術(shù)后眼瞼缺損的整復方法,為臨床上的診斷和治療提供幫助。 方法:2008年5月至2011年1月于河北醫(yī)科大學第二醫(yī)院就診的14(14只眼)例患者,全部病例術(shù)中送冰凍切片確定腫物性質(zhì)及侵犯范圍,治療后經(jīng)活組織病理檢查證實確為瞼板腺癌。其中女12例,男2例;左眼10例,右眼4例;年齡37～72歲。侵及上瞼者11例,侵及下瞼者2例,侵及球后組織和眶壁骨質(zhì)1例。術(shù)中均做冰凍切片證實為瞼板腺癌,并且切緣均為陰性后再做修復手術(shù)。根據(jù)瞼板腺癌切除術(shù)后,組織缺損大小和形態(tài)設(shè)計不同的修復方案。為使整復手術(shù)達到最好治療效果,將Mohs[4]顯微外科手術(shù)應(yīng)用其中。Mohs顯微外科手術(shù)具有兩大優(yōu)點,一是治愈率高,復發(fā)及轉(zhuǎn)移率低。此法采用水平取樣,既能檢測病灶側(cè)面,也能檢測病灶底部有無殘余腫瘤;二是最大程度保存了正常組織,避免無謂地擴大手術(shù)創(chuàng)面,這對敏感的眼瞼美容部位起到了重要作用。 結(jié)果:14例瞼板腺癌患者腫物切除術(shù)后根據(jù)眼瞼缺損的部位和大小選擇不同的修復方案,隨訪6-18個月,均取得了良好的臨床效果。 結(jié)論:對于無明顯損害的眼瞼腫物,手術(shù)切除及切除后的病理檢查對降低誤診率,提高檢出率有重要意義,對病人的預(yù)后也有長遠影響。而近年來隨著對Mohs顯微外科手術(shù)(Mohs' micrographic surgery )認識的加深,手術(shù)治愈瞼板腺癌也逐漸成為可能。手術(shù)方式及重建材料的選擇主要依據(jù)病變部位、腫瘤大小、浸潤深度以及患者全身情況而定。其原則是在盡可能徹底切除腫瘤組織的前提下,同時充分考慮到患者的美容問題及眼瞼的功能。
[Abstract]:Objective: meibomian adenocarcinoma is a highly malignant, potentially fatal tumor that originates from the tarsal plate and occurs in the Meibomian gland of the eyelid, while a few may occur in the Zeis gland at the palpebral margin. It is difficult to identify the tumor at an early stage, once it is found, It is difficult to define its scope. It is difficult to control because of the characteristics of leaping growth. Early diagnosis and extensive resection are the key to successful treatment. It should be distinguished from chalazulitis, conjunctivitis, conjunctivitis and basal cell carcinoma [1]. Therefore, surgical excision and pathological examination of ocular and facial masses without obvious damage are very important [3] .Metropion adenocarcinoma is often misdiagnosed in the elderly, and the surgical treatment is not complete, leading to orbital destruction and metastasis. Radiotherapy is insensitive and can only be used as adjuvant therapy. This study discussed the clinical characteristics of tarsal adenocarcinoma and the methods of diagnosis and reconstruction of eyelid defect after operation of tarsal adenocarcinoma. Methods: from May 2008 to January 2011, 14 eyes (14 eyes) were treated in the second Hospital of Hebei Medical University. Frozen sections were sent to all patients during operation to determine the nature of the tumor and the extent of invasion. After the treatment, it was confirmed by histopathological examination, including 12 women (2 males), 10 left eyes (10 cases) and 4 right eyes (4 cases). The age was 3772 years old. 11 cases were involved in the upper eyelid and 2 cases in the lower eyelid. One case was involved in retrobulbar tissue and orbital wall bone. Frozen sections were performed during the operation to confirm the tarsal adenocarcinoma, and the margin was negative and then repaired. According to the results of resection of tarsal adenocarcinoma, In order to achieve the best therapeutic effect, the application of Mohs [4] microsurgery has two advantages, one of which is the high cure rate. The rate of recurrence and metastasis is low. This method can not only detect the side of the lesion, but also detect the residual tumor at the bottom of the lesion. The second is that the normal tissue is preserved to the maximum extent to avoid the unnecessary expansion of the surgical wound. This is sensitive to the eyelid beauty site played an important role. Results according to the site and size of eyelid defect, 14 cases of adenoma of blepharopian plate were treated with different repair methods. The follow-up period was 6 to 18 months, and good clinical results were obtained. Conclusion: for the eyelid masses without obvious damage, the pathological examination after surgical resection and resection is of great significance in reducing the misdiagnosis rate and increasing the detection rate. In recent years, with the deepening of the knowledge of Mohs microsurgery and Mohs' micrographic surgery, it is possible to cure tarsal adenocarcinoma by operation. The choice of surgical methods and reconstruction materials is mainly based on the location of the lesion. The principle is to remove tumor tissue as thoroughly as possible, taking full account of the cosmetic problems of the patient and the function of the eyelid.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R739.7

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