眼眶神经鞘瘤术前组织学判断和治疗方法研究

发布时间：2018-06-23 16:46

本文选题：眼眶神经鞘瘤 + 临床表现　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的眼眶神经鞘瘤绝大多数为良性肿瘤,患者以眼球突出、视力下降、眼动障碍或复视等就诊,眶内肿瘤常引起眼部这些改变,与眶内其他肿瘤不易鉴别。肿瘤生长位置变化较大,瘤外包膜菲薄,术中囊膜破裂肿瘤残留往往是导致肿瘤术后复发的主要原因。本文研究目的主要是通过临床和影像学分析做出肿瘤组织学判断,根据肿瘤位置和范围制定最佳手术方案,取得最佳预后。方法收集天津医科大学第二医院眼科1985年至2014年间经病理组织学确诊的眼眶神经鞘瘤226例,通过分析这些病例的临床表现、影像学特征以及查阅相关文献以分析、总结该病的临床特点,提高术前诊断正确率。总结本文病例资料以及借鉴国内外关于本病的治疗经验,探讨该病的最佳治疗方法。结果1、临床表现:患者多以渐进性眼球突出就诊,典型临床表现为眼球突出、视力下降、扪及肿物以及眼球运动障碍。2、影像学检查结果:B型超声检查(B mode ulthasonography)肿瘤内回声多不均匀,占57.00%,多为实体回声显示大小不等无回声区。彩色多普勒(color Doppler imaging,CDI)检查显示肿瘤血流分布多样。CT(computed tomography,CT)检查显示肿瘤分布位置广泛,以上方及外侧居多,常累及眼眶后1/3段。形状多样,主要为长条形及类圆形。磁共振成像(magnetic resonance imaging,MRI)检查显示肿瘤内部信号丰富,特别是T2WI像,以低、中、高混杂信号为主。3、术式选择:前路开眶术、外侧开眶术、内侧开眶术、内外联合开眶术、眶内容切除术以及经颅开眶术分别为89例、110例,5例、9例、5例、4例。行外侧开眶术者较前路开眶术者并发上睑下垂、视力下降、眼动受限风险大。累及眶后1/3段行前路开眶术较外侧开眶术肿瘤易残余,未累及者则无差异。4.良恶性鉴别及处理原则:当发现肿瘤生长较快,疼痛感明显,眼眶骨壁有破坏时,应高度怀疑恶性病变。良性肿瘤未累及眶后1/3段多采用前路开眶术,累及眶后1/3段肿瘤多采用外侧开眶术。恶性肿瘤需行肿瘤扩大切除术或眶内容摘除术,术后辅助放射治疗。恶性者较良性易复发。结论大多数眼眶神经鞘瘤可通过影像学检查确定术前组织学判断。B型超声显示肿瘤内部回声少且不均匀,实体肿瘤内显示数个小片状或融合成片透声区,应高度怀疑为眼眶神经鞘瘤。CT显示肿瘤呈串珠状或葫芦状生长,或呈与眼轴平行长条形或长锥形生长时,多为眼眶神经鞘瘤,结合经眶上裂向颅内海绵窦区蔓延基本可以肯定诊断。哑铃形生长眶颅沟通肿瘤,哑铃形中间部在眶上裂处,两端分别在眶内和海绵窦区,眶顶骨质不增厚或缺失,亦应高度怀疑神经鞘瘤可能。MRI显示肿瘤T2WI呈低、中、高混杂信号,结合肿瘤特殊形状,如串珠状、长条形、哑铃形等,多数可以肯定为眼眶神经鞘瘤。未及眶后1/3段肿瘤、粘连不严重者多行前路开眶术,累及眶后1/3段粘连严重者可选择外侧开眶术,若位置靠近内侧、体积较大,可联合内侧开眶术。眶颅沟通者开眶取出苦难者可考虑经颅开眶。良性肿瘤多选择肿瘤局部切除术,恶性肿瘤需行肿瘤扩大切除术或眶内容切除术。
[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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.7

【参考文献】