摘要
目的探讨评估眼睑淀粉样变性的手术治疗及临床疗效。方法回顾性病例研究。收集整理2015年6月至2016年12月汉口爱尔眼科医院手术治疗27例(32只眼)眼睑淀粉样变性患者的临床资料并进行分析研究。其中单纯眼睑肿物2例(2只眼),结膜肿物3例(4只眼),病变侵犯眼睑和结膜22例(26只眼),其中18例(22只眼)伴有上睑下垂,4例(4只眼)伴有下睑内翻倒睫。所有患者均接受手术治疗,手术切除联合睑板腺刮勺逐层刮除肉眼所见病变组织(避免因追求彻底而损伤睑板、提上睑肌及下睑缩肌复合体等),切刮的组织送病理检查。术中根据病情,联合矫正上睑下垂、内翻倒睫并修复组织缺损(结膜瓣移植、羊膜移植或硬腭黏膜移植),术后联合使用盐酸奥洛他定及普拉洛芬滴眼液。结果所有手术切刮送检肿物的病理学诊断均为淀粉样变性(术前术后一致率达90.63%)。伴有上睑下垂者,矫正上睑下垂后,同时2只眼联合结膜瓣移植,4只眼联合羊膜移植,3只眼硬腭黏膜移植;伴有下睑内翻倒睫者,矫正内翻倒睫后,同期2只眼联合硬腭黏膜移植;伴有结膜肿物者,1只眼结膜瓣移植,3只眼联合羊膜移植。术后随访时间为3~15个月,其中1只眼下睑因切除睑板组织过多出现畸形而再次手术修复,5只眼因上睑位置过矫或欠矫而再次手术矫正,1只眼病变组织复发,1只眼病灶继续进展,其余24只眼未见病情进展或复发。结论眼睑组织淀粉样变性可导致眼睑外观变形、功能损伤。手术治疗效果明显,术中同期修复眼睑及结膜组织缺失,可修复眼睑正常形态及功能;术后规范药物治疗可减少疾病复发或继续进展。
Objective To evaluate the surgical treatment and clinical efficacy of eyelid amyloidosis.Methods Retrospective case study.Clinical data of 27 patients(32 eyes)with eyelid amyloidosis were collected and analyzed.Patients underwent eye plastic surgeries at Hankou Aier Ophthalmic Hospital between June 2015 and December 2016.Manifestation included eyelid tumors(2 patients),conjunctival tumors(3 patients),and invasive eyelid and conjunctival lesions(22 patients),among which 18 patients had ptosis and 4 patients had lower eyelid entropion.All patients underwent surgical treatment.Surgical resection combined with meibomian gland scraping layer by layer was conducted to remove diseased tissues and to avoid damages to tarsal plate,levator muscle and lower eyelid muscle.Dissected tissues were sent for pathological examination.Other repairs were done during the surgery when necessary.Combination of olopatadine hydrochloride and pranoprofen eye drops were prescribed after surgery.Results All pathological findings of the resected tumors were amyloidosis(consensus rate of 90.63%).Ptosis,lower lid entropion and trichiasis were corrected.Conjunctival flap transplantation,amniotic membrane transplantation or hard palate mucosa transplantation were conducted when appropriate.Patients were followed up for 3~15 months.A second surgery was required in some patients due to excessive resection of eyelid tarsal tissue(1 eye),overcorrection or undercorrection of upper eyelid position(5 eyes),recurred(1 eye)or progressed(1 eye)amyloidosis.All other eyes(n=24)were treated successfully.Conclusions Eyelid tissue amyloidosis can lead to deformity of eyelid and dysfunction.The efficacy of surgical treatment was obvious,and the eyelid and conjunctival tissue defects can be repaired simultaneously during the operation to restore normal shape and function of the eyelid;postoperative standard drug therapy can reduce the recurrence of the disease or prevent its progress.
作者
杜芳
黎冬平
王育红
Du Fang;Li Dongping;Wang Yuhong(Hankou Aier Eye Hospital,Wuhan,Hubei 430021,China)
出处
《临床眼科杂志》
2018年第3期246-249,共4页
Journal of Clinical Ophthalmology
关键词
淀粉样变性
眼睑
结膜
手术
Amyloidosis
Eyelid
Conjunctiva
Surgery
