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目的探讨改良经颅眶上外侧壁入路治疗眶尖区肿瘤的手术方法、适应证及效果。方法对2011年1月至2012年12月间经颅眶手术治疗的50例眶尖区肿瘤患者的临床资料进行分析。结果眶-翼点入路手术患者20例,眶-额与眶-颧以及颧-翼联合入路手术患者30例。肿瘤全切除35例(70.0%),肿瘤次全切除8例(16.0%),大部分或者部分切除6例(12.0%),活检1例(2.0%)。眶尖区肿瘤病理类型主要为脑膜瘤、神经源性肿瘤、血管/淋巴管源性肿瘤和泪腺源性肿瘤,分别占42.0%、32.0%、20.0%和6.0%。50例患者出院时,视力功能较治疗前有明显改善或无加重者20例,单纯眼睑下垂5例,眼球轻微活动受限7例(4例伴有眼睑下垂,3例复视),严重动眼神经损伤5例(1例神经鞘瘤,2例转移瘤,2例脑膜瘤),视力下降或者失明3例(2例视神经本身伴有肿瘤,1例颅眶沟通性神经鞘膜瘤)。术后6个月至1年随访观察显示,单纯眼睑下垂患者完全恢复,眼球轻微活动受限的临床症状完全消失,严重动眼神经损伤患者症状明显减轻,视力下降患者视力恢复正常。本组患者无复发和死亡。结论临床上采取改良经颅眶上外侧壁入路治疗眶尖区肿瘤是可行的,操作中应选取合适的角度,并加强神经功能的保护,降低并发症的发生,提高临床治疗总体效果。
Objective To investigate the surgical methods, indications and effects of transcranial supraorbital lateral wall approach for treatment of orbital apex tumor. Methods The clinical data of 50 patients with orbital apex tumors treated with transcranial orbital surgery from January 2011 to December 2012 were analyzed. Results Twenty patients underwent orbital-pterional approach and 30 patients underwent orbital-frontal orbital-zygomatic zygomatic-zygomatic approach. Total tumor resection was performed in 35 cases (70.0%), tumor subtotal resection in 8 cases (16.0%), partial or partial resection in 6 cases (12.0%) and biopsy in 1 case (2.0%). The pathological types of the orbital apex were mainly meningioma, neurogenic tumor, vascular / lymphatic vessel tumor and lacrimal gland tumor, accounting for 42.0%, 32.0%, 20.0% and 6.0% respectively. 50 patients were discharged from hospital, visual acuity was significantly improved or no worsening than before treatment in 20 cases, 5 cases of simple eyelid ptosis, 7 cases of limited eye activity limited (4 cases with ptosis, 3 cases of diplopia), severe In 5 eyes (1 schwannomatosis, 2 metastases and 2 meningiomas), 3 eyes showed decreased vision loss or blindness (2 cases of optic nerve itself accompanied by tumor and 1 case of cranio-orbital communicating nerve sheath tumor). Postoperative 6 months to 1 year follow-up observation showed that patients with pure eyelid ptosis completely recovered, the clinical symptoms of limited eye activity completely disappeared, patients with severe oculomotor nerve injury significantly reduced symptoms, vision loss in patients with normal visual acuity. This group of patients without recurrence and death. Conclusion It is feasible to improve the transorbital supraorbital lateral wall approach to treat the tumor in the orbital apex in clinical practice. Appropriate angle should be selected in the operation and the protection of neurological function should be strengthened to reduce the incidence of complications and improve the overall effect of clinical treatment.