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目的分析眼睑皮脂腺腺癌的临床及组织病理学特征,为临床诊断及治疗提供参考。设计回顾性病例系列。研究对象组织病理学检查确诊为眼睑皮脂腺腺癌患者67例。方法对北京同仁医院10年间(1996～2005年)存档的67例眼睑皮脂腺腺癌患者的临床及病理资料进行回顾性分析。主要指标眼睑皮脂腺腺癌的临床表现、组织起源、侵犯部位、分化程度、治疗及局部复发率。结果67例患者中女性36例,男性31例,临床首诊正确率43.28%,误诊为霰粒肿者占25.37%,误诊为基底细胞癌和麦粒肿者各占7.46%。组织病理学首诊正确率为79.10%,常被误诊为基底细胞癌(5.97%)及鳞状细胞癌(1.49%)。17.91%的患者首诊治疗为局部消炎,14.93%的患者首诊时未得到任何治疗。61.19%患者伴结膜上皮层或皮肤表皮层浸润(派杰样改变)。局部复发率为58.21%,局部淋巴结转移率为13.04%,以腮腺及颌下腺淋巴结受累为主,8.7%患者死于全身转移,5年生存率为94.87%。结论眼睑皮脂腺腺癌患者首诊1/3患者得不到正确诊断与及时、有效的治疗,导致病情进展。患者局部复发率仍较高。
Objective To analyze the clinical and histopathological features of eyelid sebaceous adenocarcinoma and provide reference for clinical diagnosis and treatment. Design retrospective case series. The subjects were histopathologically diagnosed as eyelid sebaceous adenocarcinoma in 67 patients. Methods The clinical and pathological data of 67 patients with eyelid sebaceous gland adenocarcinoma filed in Beijing Tongren Hospital during 10 years (1996-2005) were retrospectively analyzed. The main indicators Eyelid sebaceous gland adenocarcinoma clinical manifestations, origin of the organization, the location of invasion, degree of differentiation, treatment and local recurrence rate. Results Among the 67 patients, 36 were women and 31 were males. The accuracy rate of the first diagnosis was 43.28%, the rate of misdiagnosis as chalazion was 25.37%, and the rate of misdiagnosis as basal cell carcinoma and the stool were 7.46%. Histopathology was the first diagnosis of 79.10%, often misdiagnosed as basal cell carcinoma (5.97%) and squamous cell carcinoma (1.49%). In 17.91% of the patients, the first treatment was local anti-inflammatory, while 14.93% of the patients did not receive any treatment at the first visit. 61.19% of patients with conjunctival epithelial or cutaneous epidermal infiltration (sentinel-like change). The local recurrence rate was 58.21%. The rate of local lymph node metastasis was 13.04%. The parotid gland and submandibular gland lymph node involvement was the main cause. 8.7% of patients died of systemic metastasis. The 5-year survival rate was 94.87%. Conclusions The patients with eyelid sebaceous gland adenocarcinoma can not get the correct diagnosis and timely and effective treatment in the first one third of the patients, leading to the progression of the disease. Local recurrence rate is still high.