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目的探讨眼眶神经纤维瘤的手术切除和即期整复治疗方法及其疗效。方法采用回顾性分析,选择2002年1月至2005年12月上海交通大学医学院附属第九人民医院眼科收治的26例(26只眼)眼眶神经纤维瘤患者,收集行肿瘤切除和即期整复治疗的临床资料和随访结果。按Jackson 分型法进行分型,其中Ⅰ型12例,Ⅱ型10例,Ⅲ型4例。肿瘤部分或次全切除后依据眼睑、眼眶畸形情况,分别对Ⅰ型患者行眼睑整复术,包括眼睑缩短、外眦韧带固定、外眦成形和上睑下垂矫正术。Ⅱ型患者行眼睑整复联合眼眶重建术,Ⅲ型患者行眼睑整复、眼眶重建联合羟基磷灰石(HA)眼座植入术或保留无视功能的眼球。术后随访12～30个月。结果26例患者行肿瘤部分或次全切除术后随访期内未见肿瘤快速生长。10例患者术后视力得到提高,12例患者视力保持不变。26例患者行眼睑整复术后外形良好,其中2例因上睑下垂复发再次手术。10例患者经眼眶重建术后眼眶外形和眼球突出度与对侧眼基本对称。2例患者行 HA 眼座植入术,2例患者保留无功能眼球,术后随访外观恢复良好。26例患者均未出现严重并发症。结论眼眶神经纤维瘤的部分或次全切除手术是完全有效的,依据肿瘤的不同类型进行即期眼睑、眼眶和眼球的整复手术,可获得外观和/或功能的共同改善。
Objective To investigate the surgical resection and immediate repair of orbital neurofibroma and its curative effect. Methods A retrospective analysis was conducted to select 26 patients (26 eyes) with orbital neurofibroma underwent ophthalmology in the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2002 to December 2005. All patients underwent resection and immediate surgery Clinical data and follow-up results. According to Jackson classification, 12 cases were type I, 10 cases were type II and 4 cases were type III. According to the eyelid and orbit deformity after partial or subtotal resection of the tumor, type Ⅰ patients underwent eyelid plastic surgery, including shortening of the eyelid, fixing of the external circumflex cuff, alveoli formation and correction of ptosis. Type Ⅱ patients underwent eyelid reconstruction combined with orbital reconstruction, type Ⅲ patients underwent eyelid reconstruction, orbital reconstruction combined with hydroxyapatite (HA) ocular implantation or to retain the blind eye function. The patients were followed up for 12 to 30 months. Results Tumor growth was not observed in 26 patients after partial or subtotal resection. Postoperative visual acuity improved in 10 patients, and visual acuity remained unchanged in 12 patients. Twenty-six patients had good shape after eyelid surgery, and 2 of them had reoperation due to ptosis recurrence. Ten patients underwent orbital reconstruction of the orbital shape and eyeball protrusion and the opposite side of the eye is basically symmetrical. Two patients underwent ocular eyelid implantation, and two patients retained non-functioning eyeballs. The postoperative follow-up appearance recovered well. None of the 26 patients experienced serious complications. Conclusions Part or subtotal resection of orbital neurofibroma is completely effective and the combined improvement in appearance and / or function may be achieved by immediate reconstructive surgery of the eyelids, orbits, and eyeballs depending on the type of tumor.