McCary W S, Levine P A
Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Otolaryngol Clin North Am. 1995 Dec;28(6):1231-8.
Malignant neoplasms of the nose and paranasal sinuses typically manifest at a late stage and commonly abut or invade the orbit. Careful ophthalmologic examination and fine-cut CT provide the most accurate preoperative assessment of orbital involvement, providing guidance for treatment with a combination of radiation therapy and surgical resection. Although some surgeons still aggressively remove the eye when tumor abuts or involves limited periorbita, we have shown that this approach is unnecessarily ablative. The cosmetic, functional, and psychologic consequences of the loss of an eye mandate that every effort should be made to preserve the eye as long as oncologic safety is not compromised. The evidence is mounting that this is safe and organ sparing, and leaves functioning eyes. With the use of preoperative radiation therapy and frozen-section control of the periorbita, the eye can often be spared without increasing local recurrences or survival, and adequate postoperative function can be maintained.
鼻及鼻窦恶性肿瘤通常在晚期出现，且常紧邻或侵犯眼眶。细致的眼科检查和薄层CT能提供关于眼眶受累情况最准确的术前评估，为放疗和手术切除联合治疗提供指导。尽管一些外科医生在肿瘤紧邻或累及有限的眶周组织时仍积极摘除眼球，但我们已表明这种方法是不必要的破坏性操作。失去一只眼睛所带来的美容、功能和心理影响要求，只要不影响肿瘤学安全性，就应尽一切努力保留眼球。越来越多的证据表明，这样做是安全且能保留器官的，能保留有功能的眼睛。通过术前放疗和眶周组织的冰冻切片控制，通常可以在不增加局部复发率或影响生存率的情况下保留眼球，并维持足够的术后功能。
