复发性眶内占位性病变：253 例临床病理研究。
Recurrent orbital space-occupying lesions: a clinicopathologic study of 253 cases.
机构信息
Department of Ophthalmology, the First Hospital Affiliated to PLA General Hospital, Beijing 100048, China;
出版信息
Chin J Cancer Res. 2013 Aug;25(4):423-9. doi: 10.3978/j.issn.1000-9604.2013.08.04.
OBJECTIVE
To analyze the clinical features, histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions.
METHODS
A retrospective study was carried out in 253 consecutive patients with recurrent orbital space-occupying lesions treated by surgical excision in the Institute of Orbital Diseases, the General Hospital of the Armed Police Force from January 2009 to December 2010.
RESULTS
The patients included 123 males and 130 females aged 2 to 78 years (mean, 36.2 years), and the last recurrence interval after operation ranged from 1 month to 40 years (median, 4.75 years). Of all the cases, 159 (62.8%), 65 (25.7%), 20 (7.9%), 8 (3.2%) and 1 (0.4%) had previously experienced once, twice, three, four and six times of surgeries, respectively. Among them, 29 (11.5%) cases had recurred 3 times or over, and 37 (14.6%) cases got recurrence in 10 or more years postoperatively. Most of the patients with local recurrence presented with various clinical manifestations, while 31 (12.3%) cases were symptom-free. Two hundred and thirty-one (91.3%) cases underwent surgical removal of the recurrent orbital lesions, and another 22 (8.7%) cases had to receive the exenteration of orbit. Categories of these recurrent orbital lesions after operation were as follows: lacrimal gland tumors, 65 (25.7%) cases; vasogenic diseases, 54 (21.3%) cases; neurogenic tumors, 42 (16.6%) cases; secondary tumors, 24 (9.5%) cases; orbital inflammation, 21 (8.3%) cases; myogenic tumors, 14 (5.5%) cases; fibrous and adipose tumors, 12 (4.7%) cases; lympho-hematopoietic tumors, 7 (2.8%) cases; bone or cartilage tumors, 7 (2.8%) cases; orbital cysts, 6 (2.4%) cases; and indefinitely differentiated tumor, 1 (0.4%) case. The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma, hemangiolymphangioma, lacrimal gland adenoid cystic carcinoma, meningioma, inflammatory pseudotumor, neurofibroma, sebaceous gland carcinoma, vascular malformation, rhabdomyosarcoma and hemangioma.
CONCLUSIONS
The variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions. The lacrimal gland epithelial tumor is most prone to relapse after resection, and early and longer-term postoperative follow-up is needed.
目的
分析复发性眼眶占位性病变的临床特征、组织病理学分类和各种类型的发生频率。
方法
对 2009 年 1 月至 2010 年 12 月武警部队总医院眼眶病研究所 253 例经手术切除治疗的复发性眼眶占位性病变患者进行回顾性研究。
结果
患者包括男性 123 例，女性 130 例，年龄 2 至 78 岁（平均 36.2 岁），术后最后一次复发间隔 1 个月至 40 年（中位数 4.75 年）。所有病例中，分别有 159 例（62.8%）、65 例（25.7%）、20 例（7.9%）、8 例（3.2%）和 1 例（0.4%）经历过 1 次、2 次、3 次、4 次和 6 次手术。其中 29 例（11.5%）复发 3 次以上，37 例（14.6%）术后 10 年以上复发。大多数局部复发患者表现出各种临床表现，而 31 例（12.3%）无症状。231 例（91.3%）患者行复发性眼眶病变切除术，另 22 例（8.7%）患者行眶内容剜除术。术后复发性眼眶病变分类如下：泪腺肿瘤 65 例（25.7%）、血管源性疾病 54 例（21.3%）、神经源性肿瘤 42 例（16.6%）、继发性肿瘤 24 例（9.5%）、眼眶炎症 21 例（8.3%）、肌源性肿瘤 14 例（5.5%）、纤维脂肪肿瘤 12 例（4.7%）、淋巴造血肿瘤 7 例（2.8%）、骨软骨肿瘤 7 例（2.8%）、眼眶囊肿 6 例（2.4%）和未分化肿瘤 1 例（0.4%）。前 10 种主要的组织病理学诊断为泪腺多形性腺瘤、血管淋巴管瘤、泪腺腺样囊性癌、脑膜瘤、炎性假瘤、神经纤维瘤、皮脂腺癌、血管畸形、横纹肌肉瘤和血管瘤。
结论
术后复发性眼眶病变主要包括肿瘤，除血管畸形和眼眶炎症性病变外。切除后泪腺上皮肿瘤最易复发，需要早期和长期的术后随访。
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