泪小点肿物的手术方法探讨
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摘要
目的探讨泪小点肿物切除并喇叭状泪小点成形的手术方法。方法 2011年1月至2014年5月在我院手术的泪小点肿物患者14例(14只眼)。显微镜下手术,沿肿物外1 mm完整切除肿物,分离泪小管并向内分离睑结膜,向外分离眼睑皮肤,用9-0尼龙线将泪小管口与移行的睑结膜、皮肤对位缝合,使泪小管开口呈喇叭状敞开,其中5例置入Crawford泪道引流管。肿物做病理检查。随访3~6个月。结果术后1周拆线,1个月后拔出泪道引流管。术后泪小点开口呈喇叭状开放,置入泪道引流管者泪小点圆且大,泪道冲洗通畅。睑缘位正,无肿物复发。14例泪小点肿物病理报告色素痣10例,乳头状瘤2例,表皮样囊肿1例,肉芽肿1例。结论泪小点肿物切除并喇叭状泪小点成形术,既改善眼睑外观,又恢复泪小点引流功能;置入泪道引流管,可避免泪小点狭窄,术后疗效佳,是很好的手术方式。
Objective To explore the surgical treatments for peripunctal neoplasm. To observe the effects of tumorectomy and lacrimal punctoplasty. Methods Fourteen patients( 14 eyes) received the surgical treatments in our hospital between January 2011 and May 2014. All surgeries were performed under microscope. The neoplasm was completely excised with 1mm edge. The opening of the remaining canaliculus was recognized and separated,as well the palpebral conjunctiva and the eyelid skin. Canaliculus,palpebral conjunctiva and eyelid skin were then sutured together with 9-0 nylon to maintain the patency of the puncta. Crawford cannula was intubated in 5 patients. Excised neoplasm was sent to pathologists to confirm the diagnosis. Results Stiches were removed 1 week after the surgery. The tube was removed at 1 month.The lacrimal puncta maintained patent. The patient with intubation had a big and round puncta after removing the tube. No recurrence occurred. Histopathology showed nevus in 10 cases,papilloma in 2 cases,dermal cyst in 1 case and granuloma in 1 case. Conclusion Tumorectomy combined with lacrimal punctoplasty is a good choice to treat peripunctal neoplasm.It improves the appearance and restores the drainage function of lacrimal puncta. Combination with intubation can prevent the punctal stenosis.
Objective To explore the surgical treatments for peripunctal neoplasm. To observe the effects of tumorectomy and lacrimal punctoplasty. Methods Fourteen patients( 14 eyes) received the surgical treatments in our hospital between January 2011 and May 2014. All surgeries were performed under microscope. The neoplasm was completely excised with 1mm edge. The opening of the remaining canaliculus was recognized and separated,as well the palpebral conjunctiva and the eyelid skin. Canaliculus,palpebral conjunctiva and eyelid skin were then sutured together with 9-0 nylon to maintain the patency of the puncta. Crawford cannula was intubated in 5 patients. Excised neoplasm was sent to pathologists to confirm the diagnosis. Results Stiches were removed 1 week after the surgery. The tube was removed at 1 month.The lacrimal puncta maintained patent. The patient with intubation had a big and round puncta after removing the tube. No recurrence occurred. Histopathology showed nevus in 10 cases,papilloma in 2 cases,dermal cyst in 1 case and granuloma in 1 case. Conclusion Tumorectomy combined with lacrimal punctoplasty is a good choice to treat peripunctal neoplasm.It improves the appearance and restores the drainage function of lacrimal puncta. Combination with intubation can prevent the punctal stenosis.
引文
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[3]Goto H,Yamamoto T,Ishiyama Z,et al.Adenoid cystic carcinoma arising from the lower eyelid.Jpn J Ophthalmol,2006,50:374-376.
[4]Scott KR,Jakobiec FA,Font RL.Peripunctal melanocytic nevi.Distinctive clinical findings and differential diagnosis.Ophthalmology,1989,96:994-998.
[5]Hwang CS,Lee S,Yen MT.Peripunctal melanocytic nevus.Int Ophthalmol,2011,31:497-499.
[6]雷海珠.泪小点周围眼睑小肿物的临床治疗.国际眼科杂志杂志,2012,12:377-378.
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