【摘要】：目的：分析145例眼眶占位性病變的組織病理學分類及分布情況,了解眶內(nèi)腫瘤的影像學特點及在眼眶各區(qū)的分布,提高眼眶占位性病變術前診斷的正確率。 方法：回顧性分析2003年4月-2010年6月青島大學醫(yī)學院附屬醫(yī)院診斷眼眶占位性病變并有病理證實的患者。將145例患者的病理診斷按照國際公認的Shields病理學分類方法進行分類,統(tǒng)計各種病變的病理分類以及各年齡組的常見病變構(gòu)成情況,分析眼眶占位性病變的臨床特點�？偨Y(jié)常見眼眶腫瘤的影像學特征,按照四分區(qū)法對眼眶占位性病變進行分析,了解眶內(nèi)病變在眼眶各區(qū)的分布情況。 結(jié)果：在145例眼眶占位性病變中,原發(fā)性眼眶腫瘤141例(97.2%),繼發(fā)性眼眶腫瘤3例(2.1%),轉(zhuǎn)移性眼眶腫瘤1例(0.7%)。按組織來源分類排在首位的是脈管源性病變41例(28.2%),接下來分別為囊腫性病變37例(25.5%),淚腺源性(上皮來源)21例(14.4%),炎癥性病變14例(9.6%),淋巴造血系統(tǒng)病變11例(7.6%)。本研究中良性病變121例(83.4%),其中前4位依次為海綿狀血管瘤、皮樣囊腫、多形性腺瘤、炎性假瘤。惡性病變24例(16.6%),前4位依次為惡性淋巴瘤,淚腺腺癌,脈絡膜惡性黑色素瘤球外蔓延,腺樣囊性癌。兒童組(18歲以下)患者中最常見的病變?yōu)槠幽夷[20例(13.8%),其次為表皮樣囊腫4例(2.7%)和脂肪瘤4例(2.7%)；中青年組(19-59歲)患者中最常見良性腫瘤為海綿狀血管瘤32例(22%),最常見的惡性腫瘤為淋巴瘤3例(3.4%)；老年組(60歲以上)患者中最常見良性腫瘤為海綿狀血管瘤3例(11.5%),最常見的惡性腫瘤為淋巴瘤8例(30.7%)和淚腺腺癌3例(11.5%)。影像學檢查示良性腫瘤大多呈圓形、橢圓形腫塊,與周圍組織邊界清,無骨質(zhì)破壞；惡性腫瘤大多邊界不清,形狀不規(guī)則,與周圍組織分界不清,往往伴有骨質(zhì)破壞。肌錐外區(qū)占位性病變最多(56,38.6%),眼球筋膜囊區(qū)最少(5,3.4%)。眼球筋膜囊區(qū)、骨膜外區(qū)病變均為良性(100%)。肌錐內(nèi)區(qū)良性病變33例(94.3%)惡性病變2例(5.7%)；肌錐外區(qū)良性病變46例(82.1%),惡性病變10例(17.9%)混合型良性病變7例(36.8%),惡性病變12例(63.2%)。海綿狀血管瘤主要分布于肌錐內(nèi)區(qū),淚腺源性病變主要分布于肌錐外區(qū),所有淋巴瘤均累及肌錐外區(qū), 結(jié)論：眼眶占位性病變種類較多,海綿狀血管瘤和淋巴瘤分別是最常見的良性和惡性眼眶腫瘤,皮樣囊腫和表皮樣囊腫是兒童發(fā)生眼眶占位性病變最主要的病因。各種眶內(nèi)占位性病變的影像學均有一定的特征性,眼眶良、惡性病變在肌錐內(nèi)區(qū)、肌錐外區(qū)及混合型的分布有差異。結(jié)合患者的臨床表現(xiàn)、影像學特點及腫瘤所處位置有助于明確術前診斷,制定正確的治療方案。
[Abstract]:Objective: to analyze the histopathological classification and distribution of orbital space-occupying lesions in 145 cases, to understand the imaging features of orbital tumors and their distribution in orbital regions, and to improve the accuracy of preoperative diagnosis of orbital space-occupying lesions. Methods: from April 2003 to June 2010, the patients with orbital space occupying lesions diagnosed by the affiliated Hospital of Qingdao University Medical College were analyzed retrospectively. The pathological diagnosis of 145 patients was classified according to the internationally recognized Shields pathological classification method. The pathological classification of all kinds of lesions and the composition of common lesions in different age groups were analyzed. The clinical features of orbital space-occupying lesions were analyzed. The imaging features of common orbital tumors were summarized and the distribution of orbital lesions in orbital regions was analyzed according to the four-zone method. Results: among 145 orbital space-occupying lesions, 141 (97.2%) were primary orbital tumors, 3 (2.1%) were secondary orbital tumors, and 1 (0.7%) was metastatic orbital tumors. According to tissue origin, 41 cases (28.2%) were vascular diseases, 37 cases (25.5%) were cyst lesions, 21 cases (14.4%) were lacrimal gland origin (epithelial origin). Inflammatory lesions were found in 14 cases (9.6%) and lymphatic hematopoietic lesions in 11 cases (7.6%). In this study, 121 cases (83.4%) were benign lesions, of which the top 4 were cavernous hemangioma, dermoid cyst, pleomorphic adenoma and inflammatory pseudotumor. Malignant lesions were found in 24 cases (16.6%), the first four were malignant lymphoma, lacrimal gland adenocarcinoma, extrabulbar extension of choroidal malignant melanoma and adenoid cystic carcinoma. The most common lesions were dermoid cysts in 20 cases (13.8%), epidermoid cysts in 4 cases (2.7%) and lipomas in 4 cases (2.7%). The most common benign tumor was cavernous hemangioma (22%) and the most common malignant tumor was lymphoma (3. 4%) in the young and middle-aged group (19-59 years old). The most common benign tumor was cavernous hemangioma (11.5%), the most common malignant tumor was lymphoma in 8 cases (30.7%) and lacrimal gland adenocarcinoma in 3 cases (11.5%). Imaging examination showed that the benign tumors were mostly round, elliptical masses, clear with the surrounding tissue boundary, no bone destruction; most malignant tumors with unclear boundary, irregular shape, not clear border with surrounding tissues, often accompanied by bone destruction. The area of extrapyramidal area occupied the most (56%), and the area of fascia sac of eyeball was the least (53.4%). The lesions of fascia capsule and extraperiosteal area were all benign (100%). 33 cases (94.3%) were benign lesions in the intraconical area and 2 cases (5.7%) were malignant lesions. There were 46 cases (82.1%) of benign lesions in the extrapyramidal area, 10 cases (17.9%) of malignant lesions, 7 cases (36.8%) of mixed benign lesions and 12 cases (63.2%) of malignant lesions. Cavernous hemangioma is mainly located in the intramuscular cone, lacrimal gland is mainly located in the extrapyramidal area, and all lymphomas involve the extrapyramidal area. Conclusion: there are more types of orbital space-occupying lesions. Cavernous hemangioma and lymphoma are the most common benign and malignant orbital tumors respectively. Dermoid cysts and epidermoid cysts are the main causes of orbital space-occupying lesions in children. The imaging features of all kinds of intraorbital space-occupying lesions have certain characteristics. The distribution of benign and malignant orbital lesions in the intrapyramidal area, extrapyramidal area and mixed type is different. Combined with the clinical manifestations, imaging features and location of the tumor, it is helpful to determine the preoperative diagnosis and make the correct treatment plan.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R739.7

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