泪器病专栏

14例眼眶泪腺导管囊肿的临床特征及手术治疗

Clinical characteristics and surgical management of 14 cases with orbital lacrimal duct cysts

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目的:探讨眼眶泪腺导管囊肿的临床特征及手术治疗方式,提高对该疾病诊疗的认识。方法:回顾性分析天津医科大学第二医院1991年1月—2023年12月经手术后病理证实的14例眼眶泪腺导管囊肿患者的临床资料。结果:14例患者中,男性9例,女性5例;年龄8个月~59岁,平均年龄为26.5岁;均为单眼,其中左眼9例,右眼5例;多以发现眼眶肿物或眼睑肿胀隆起就诊。B超/彩色多普勒超声或CT均提示囊性占位性病变。所有患者均接受了囊肿切除术,全身麻醉手术4例,局部麻醉手术10例;其中前路皮肤切口6例,结膜切口8例,辅助外眦切开3例。术中6例囊肿破裂,囊腔内注入医用透明质酸钠凝胶,辅助完整摘除囊壁。术后病理均提示泪腺导管囊肿,其中睑叶泪腺导管囊肿4例,眶叶泪腺导管囊肿4例,副泪腺导管囊肿5例,异位泪腺导管囊肿1例。术后复查未见并发症。结论:泪腺导管囊肿是临床较少见的疾病,可以发生在眼部的任何部位,结合典型的临床及影像学表现,主泪腺导管囊肿可基本明确诊断,但仍需与上皮/结膜包含性囊肿及皮样囊肿等鉴别,最终需病理确诊。手术完整切除囊肿是治疗该病的主要方法,切除不完全,有复发可能;术中辅助应用医用透明质酸钠凝胶囊内注射有助于囊肿完整摘除。
Abstract Objective:To explore the clinical characteristics and surgical treatment for lacrimal duct cyst, aiming to enhance the diagnosis and therapeutic outcomes of this disease. Method: We conducted a retrospective analysis of the clinical data from 14 patients with lacrimal duct cysts all of which were confirmed by postoperative pathology. These patients were treated at our hospital from January 1991 to December 2023. Results: Among the 14 patients,  there were 9 male and 5 females, with age ranging from 8 months to 59 years (mean: 26.5 years). All cases involved unilateral involvement, with 9 affecting the left eye and 5 affecting the right eye. The majority of patients sought medical care due to the presence of an orbital mass or eyelid swelling and protrusion. Imaging studies, including B-ultrasound, color Doppler ultrasound, or CT scans, consistently revealed cystic space-occupying lesions. All patients underwent cystectomy, with 4 cases performed under general anesthesia and 10 cases under local anesthesia.Surgical approahces included anterior skin incision in 6 cases, conjunctival incision in 8 cases, and  auxiliary lateral canthotomy in 3 cases involving. During surgery, cyst rupture occurred in 6 cases, necessitating the injection of medical sodium hyaluronate gel into the cyst cavity to facilitate the complete removal of the cyst wall. Postoperative pathological analysis confirmed the presence of lacrimal gland duct cysts, which were further classified as follows: 4 cases of eyelid lobe lacrimal gland duct cysts, 4 cases of orbital lobe lacrimal gland duct cysts, 5 cases of accessory lacrimal gland duct cysts, and 1 case of ectopic lacrimal gland duct cyst. No postoperative complications were observed in any the patients. Conclusions: Lacrimal duct cysts are relatively uncommon in clinical practice and can arise in any part of the eye. Given their typical clinical and imaging features, a primary lacrimal duct cyst can generally be diagnosed with reasonable degree of certainty. However, it is still necessary to be differentiated it from epithelial/conjunctival inclusion cysts and dermoid cysts, and other similar conditions., with the final diagnosis relying on pathological confirmation. Complete surgical resection of the cyst is the primary treatment approach for this disease, as incomplete resection may result in recurrence. Intra-capsular injection of medical sodium hyaluronate gel during surgery can aid in the complete remval of the cyst.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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