眼睑肿瘤手术切除与Ⅰ期修复的疗效观察

Clinical observation on the effect of resection of eyelid tumor and stage Ⅰ recovery

摘要:

目的：探讨采用眼睑肿瘤局部切除术+病理检查或术中冰冻切片检查，同时Ⅰ期行眼睑修复手术的临床效果。

方法：对眼睑肿瘤患者92例92眼均行局部切除+Ⅰ期行眼睑修复手术+常规病理检查(37例疑似恶性肿瘤术中行快速冰冻切片检查，如为恶性行按Mohs法切除)，并同时Ⅰ期采用自体游离硬腭黏膜移植或Hughes法修复联合眼周皮瓣重建眼睑。

结果：术后病理诊断为良性肿瘤52例，恶性肿瘤40例。全部病例皮瓣及硬腭黏膜植片等全部成活。随访均6mo以上，无1例肿瘤复发。眼睑外观和活动闭合功能满意，获得良好效果。

结论：本组病例中近一半的眼睑肿瘤病例为恶性，故更应及早手术治疗。对疑似恶性的应在术中行冰冻切片明确性质，以利于Ⅰ期切除干净，减少复发、转移。切除后根据眼睑缺损情况行Ⅰ期行修复手术，缺损较大的内层采用硬腭黏膜移植或Hughes法修复，外层皮瓣采用眼周皮瓣滑行、游离皮瓣 、风筝皮瓣、单纯对位缝合等修复。硬腭黏膜移植在上睑修复时应慎重。

Abstract:

AIM: To investigate clinical effects of local resection of eyelid tumors and pathological examination or frozen section examination as well as the stage I recovery.

METHODS: For all 92 cases 92 eyes of eyelid tumor patients who underwent local resection, reconstruction in stage Ⅰ and routine pathological examination(37 cases of suspected malignant tumors using frozen section examination. If it was malignant, excision by Moths surgery). Using free palate mucosa autograft in stage I or reconstruction by Hughes surgery combined with eye flaps repaired eyelid defects.

RESULTS: The postoperative pathological diagnosis: 52 cases were benign tumors, and 40 cases malignant tumors. All cases of eye flaps and hard palate mucosa grafts were survived. Followed up for more than 6mo, no tumor were recurred. The appearance and function of eyelid were satisfactory.

CONCLUSION: In this group of cases, nearly half of eyelid tumors are malignant tumors. It should be treated and operated as early as possible. For suspected malignant tumors, we use frozen section examination to confirm its properties in order to excision cleanly in stage Ⅰ, reducing the recurrence and metastasis. According to the eyelid defect after resection, we could do repair operation in stage Ⅰ. The inner larger defect is repaired by using hard palate mucosa transplantation or Hughes surgery. The outer layer of the eyelid defect is repaired by using eye flap glide, the free flap, the kite flap, the simple suture, etc. It should be careful when using the hard palate mucosa transplantation in the upper eyelid defect.