睑板腺癌的临床病例诊治分析

发布时间：2018-02-10 18:38

本文关键词： 恶性肿瘤睑板腺癌眼睑缺损成形术 Mohs　出处：《河北医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的:睑板腺癌是起源于睑板,发生于眼睑Meibomian腺(睑板腺)的高度恶性、有致命危险的肿瘤,少数亦可发生于睑缘的Zeis腺。肿瘤早期难以识别,一旦发现,很难界定其范围。因有跳跃性生长的特点而难以控制,早期诊断和广泛切除是成功治疗的关键。睑板腺癌女性多见于男性,发病年龄大多在50~90岁。临床诊断较为困难,需与霰粒肿、眼睑结膜炎、结膜炎及基底底细胞癌相鉴别[1],易侵犯周围组织,多经淋巴、血液转移[2]。睑板腺癌的腺体特征不典型,故无明显损害表现的眼脸肿物手术切除和病理检查至关重要[3]。睑板腺癌高发于老年人,常造成误诊。手术治疗不彻底,导致眼眶内破坏及转移死亡。睑板腺癌以手术治疗为主,放射治疗不敏感,只能作为辅助疗法应用。本研究探讨了睑板腺癌的临床特点、诊断治疗和睑板腺癌术后眼睑缺损的整复方法,为临床上的诊断和治疗提供帮助。方法:2008年5月至2011年1月于河北医科大学第二医院就诊的14(14只眼)例患者,全部病例术中送冰冻切片确定肿物性质及侵犯范围,治疗后经活组织病理检查证实确为睑板腺癌。其中女12例,男2例;左眼10例,右眼4例;年龄37～72岁。侵及上睑者11例,侵及下睑者2例,侵及球后组织和眶壁骨质1例。术中均做冰冻切片证实为睑板腺癌,并且切缘均为阴性后再做修复手术。根据睑板腺癌切除术后,组织缺损大小和形态设计不同的修复方案。为使整复手术达到最好治疗效果,将Mohs[4]显微外科手术应用其中。Mohs显微外科手术具有两大优点,一是治愈率高,复发及转移率低。此法采用水平取样,既能检测病灶侧面,也能检测病灶底部有无残余肿瘤;二是最大程度保存了正常组织,避免无谓地扩大手术创面,这对敏感的眼睑美容部位起到了重要作用。结果:14例睑板腺癌患者肿物切除术后根据眼睑缺损的部位和大小选择不同的修复方案,随访6-18个月,均取得了良好的临床效果。结论:对于无明显损害的眼睑肿物,手术切除及切除后的病理检查对降低误诊率,提高检出率有重要意义,对病人的预后也有长远影响。而近年来随着对Mohs显微外科手术(Mohs' micrographic surgery )认识的加深,手术治愈睑板腺癌也逐渐成为可能。手术方式及重建材料的选择主要依据病变部位、肿瘤大小、浸润深度以及患者全身情况而定。其原则是在尽可能彻底切除肿瘤组织的前提下,同时充分考虑到患者的美容问题及眼睑的功能。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.7

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