Comparison of the Clinical Outcome of Orbitotomy for Orbital Cavernous Hemangiomas Removal Through Transconjunctival Orbitotomy and Lateral-Medial Orbitotomy
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摘要:
目的 评估经结膜入路前路开眶术，内外侧联合开眶术，2种不同入路手术摘除肌锥内视神经内侧眼眶海绵状血管瘤的临床效果。 方法 回顾性分析云南省第二人民医院2009 年09 月至2019年09 月收治的68例眼眶海绵状血管瘤，根据术式分为A、B 2组。A组为结膜入路前路开眶术共33例，B组为内外侧联合开眶术共35例，评估2组患者在平均住院时间、手术时间、手术操作空间、术中出血量、肿瘤完整摘、术后并发症等指标，差异无统计学意义（P > 0.05）。 结果 A组平均住院天数为（5.03±1.63）d，B组为（8.34±2.13） d，两者相比差异有统计学意义（t = -4.926，P = 0.000）。A组平均手术时间为（55.62±5.43） min，B组为（109.21±13.72） min，两者相比差异有统计学意义（t = -16.428，P = 0.000）。手术操作空间用注水法测量，用所注水的体积表示，A组平均为（5.22±0.21） mL，B组平均为（16.501±1.22） mL，两者相比差异有统计学意义（t = -48.362，P = 0.000）。术中出血量：A组平均为（17.22±1.65）mL，B组平均为（59.29±6.42）mL，两者相比差异有统计学意义（t = -28.098，P = 0.000）。肿瘤完整摘除率：A组为90.9%（30/33），B组为97.14%（34/35）；术后视力：A组患者术后视力提高和不变者占93.9%（31/33），术后视力下降占6.06%（2/33）；B组术后视力提高和不变者占85.71%（30/35），术后视力下降或丧失者占14.3%（5/35）。 结论 结膜入路前路开眶术和内外侧联合开眶术在神经内侧眼眶海绵状血管瘤摘除术中各有优缺点，正确选择手术方式是完整摘除眼眶海绵状血管瘤的关键，术前应根据影像学资料准确判断肿瘤位置和大小。 -
关键词:
- 眼眶海绵状血管瘤 /
- 经结膜入路前路开眶术 /
- 内外侧联合开眶术
Abstract:Objectve To evaluate the clinical outcomes of orbitotomy for orbital cavernous hemangiomas through transconjunctival orbitotomy and lateral-medial orbitotomy. Methods A retrospective analysis was performed on 68 cases of orbital cavernous hemangioma admitted to the Second People’s Hospital of Yunnan Province from September 2009 to September 2019. All cases were divided into two groups, patients underwent transconjunctival orbitotomy were assigned in group A （33 cases）and patients underwent lateral-medial orbitotomy were assigned in group B （35 cases）. Average hospital stay, operating time, operation space, bleeding volume, complete tumor removal rate, and postoperative complications were evaluated（P > 0.05）. Results The average hospital stay was （5.03 ± 1.63）d in group A and （8.34 ± 2.13）d in group B, and the difference was statistically significant （t = -4.926, P = 0.000）. The mean operation time was （55.62 ± 5.43）min in group A and （109.21 ± 13.72）min in group B, and the difference was statistically significant （t = -16.428, P = 0.000）. The operation space was measured by water injection method, which was expressed by the volume of water injection. The average value of group A was （5.22 ± 0.21）mL, and that of group B was （16.501 ± 1.22）mL, with statistical significance （t = -48.362, P = 0.000）. Blood loss was （17.22 ± 1.65）mL in group A and （59.29 ± 6.42）mL in group B, and the difference was statistically significant （t = -28.098, P = 0.000）. The complete tumor removal rate was 90.9% （30/33） in group A and 97.14% （34/35）in group B. Postoperative visual acuity: 93.9% （31/33） of patients in group A had improved or unchanged postoperative visual acuity, and 6.06% （2/33） had decreased postoperative visual acuity. In group B, 85.71% （30/35） had improved or unchanged visual acuity, and 14.3% （5/35） had decreased or lost visual acuity. Conclusion Both transconjunctival orbitotomy and lateral-medial orbitotoy have advantages and disadvantages. The key of removing orbital cavernous hemangiomas completely is to select the right operation method. Preoperative imaging data should be used to accurately determine the location and size of the tumor. -
图 1 患者眼眶CT、MRI扫描
a ：术前CT行双眼眶水平扫描；b ：术前CT行双眼眶冠状位扫描；c ：术前CT行双眼眶矢状位扫描；d：术前CT增强扫描，注射造影剂后20 s肿瘤内出现一个高密度斑点；e 术前CT增强扫描，注射造影剂后随着时间延长，高密度斑点逐渐扩大，直至一致性增强，用时约20～60 min；f：术前MRI行双眼眶水平位扫描，T2WI为高强度信号；g：术前MRI行双眼眶冠状位扫描，T2WI为高强度信号；h：术前MRI行双眼眶矢状位扫描，T2WI为高强度信号。
Figure 1. CT and MRI scan of the patients
图 2 患者术后眼部外观照相
a：患者为结膜入路术后患者，术后无肉眼可见皮肤疤痕，仅见结膜水肿；b：患者为内外联合开眶手术入路患者，术后外眦部可见显眼的皮肤疤痕，同时可见结膜水肿。
Figure 2. Postoperative photograph of the patient’s eye appearance
表 1 住院天数、手术时间、手术操作空间、出血量比较（
$ \bar x \pm s $ ）Table 1. Comparison of days in hospital, operation time,operation room and bleeding volume （
$ \bar x \pm s $ ）项目 A组 B组 t P 住院天数（d） 5.03 ± 1.63 8.34 ± 2.13 −4.926 < 0.001* 手术时间（min） 55.62 ± 5.43 109.21 ± 13.72 −16.428 < 0.001* 手术操作空间（mL） 5.22 ± 0.21 16.501 ± 1.22 −48.362 < 0.001* 术中出血量（mL） 17.22 ± 1.65 59.29 ± 6.42 −29.029 < 0.001* *P < 0.05。 
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表 2 肿瘤完整摘除率比较[n（%）]
Table 2. Comparison of complete tumor removal rate[n（%）]
组别 完全摘除 部分摘除 χ2 P A组 30（90.90） 3（9.10） 1.192 0.275 B组 34（97.14） 1（2.86）
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表 3 术后视力比较[n（%）]
Table 3. Comparison of postoperative visual acuity [n（%）]
组别 提高和不变 下降 χ2 P A组 31（93.90） 2（6.10） 1.244 0.265 B组 30（85.71） 5（14.29）
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表 4 术后上睑下垂比较（n）
Table 4. Comparison of postoperative ptosis（n）
组别 术后上睑下垂 χ2 P A组 2 = 1.286 0.257 B组 5
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