病例研究

经皮肤切口联合鼻内窥镜入路行泪道肿瘤切除2例并文献复习

Two cases of lacrimal duct tumor resection through cutaneous incision combined with nasal endoscopic approach and literature review

:74-84
 
泪道肿瘤是比较罕见的泪道疾病。文献报道有超过55%的泪道肿瘤为恶性肿瘤,如果肿瘤不能完全切除或已经发生转移,可能会使复发率和死亡率增加。故临床上对表现为泪囊肿物的病例应详细检查,比如眼眶彩色多普勒超声、计算机断层扫描(computed tomography, CT)及磁共振成像(magnetic resonance imaging, MRI)检查,必要时行增强扫描,有条件还可以进行泪道内镜检查,充分预估病情,设计合理的手术入路和切除范围。如肿物较大或病情复杂,经过皮肤或者鼻内镜下入路作单一切口不能完整切除,可以内外路联合手术,以获得良好的视野,对肿物进行充分的游离分离,进行合适的切除。文章汇报了通过皮肤切口联合鼻内镜入路完成的2例泪道肿瘤切除术,1例术后病理为良性的乳头状瘤,术后5个月时复查未见复发,长期观察;另一例为NUT癌,确诊后患者已经至肿瘤科接受了化学治疗。提示表现为泪囊肿物的病例在术前应完善眼眶影像学检查,怀疑为恶性肿瘤时应完善全身重要脏器的检查,以充分评估病情。对于有手术指征的应选择合适的手术方案,尽量完整切除。术后应长期随访,以早期发现复发和转移,及时治疗。
Lacrimal tumors are a relatively rare disease of the lacrimal system. According to the literature, more than 55% of lacrimal tumors are malignant tumors. If the tumor cannot be completely removed or has already metastasized, it may increase the recurrence rate and mortality rate. Therefore, in clinical practice, if a case of a mass in the lacrimal sac is encountered, a thorough examination should be performed, such as orbital ultrasound scan, CT and MRI with or without contrast enhancement, and endoscopic examination of the lacrimal duct, if possible. The condition should be fully assessed to design a reasonable surgical approach and the extent of surgical resection. If the lesion is large or the condition is complex, a single incision through the skin or endoscopic approach may not be able to completely remove it, and an combined approach can be used to obtain a good view and fully dissect and separate the lesion for appropriate resection. This article reports two cases of lacrimal tumor resection performed through a skin incision combined with an endoscopic approach, one of which had a postoperative pathological diagnosis of benign papilloma and no recurrence was observed.5 months after surgery and Long-term follow-up is planned. The other case was NUT carcinoma. The patient had received chemotherapy in the oncology department of the general Hospital after diagnosis. It is suggested that the imaging examination of the orbit should be improved in the case of lacrimal tumor before operation, and the examination of the main organs of the body should be perfected when malignant tumor is suspected, so as to fully evaluate the condition. For the case with surgical indications, the appropriate surgical plan should be selected and the complete resection should be carried out as much as possible. Long-term follow-up should be carried out after surgery, so that recurrence and metastasis can be detected early, and timely treatment can be carried out.
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  • 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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