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目的研究葡萄膜神经源性肿瘤的手术方式和长期术后效果。设计回顾性病例系列。研究对象1999-2011年在北京同仁医院接受局部肿瘤切除的葡萄膜神经源性肿瘤患者15例(15眼)。方法观察记录患者的术前临床特征、手术方式、术后效果、组织病理学检查。主要指标术前视力、肿瘤的位置和大小、术后视力、并发症。结果 15例患者中睫状体肿瘤7例(46.7%),睫状体脉络膜肿瘤2例(13.3%),脉络膜肿瘤6例(40%)。组织病理学检查:10例神经鞘瘤,4例神经胶质瘤,1例神经纤维瘤。肿瘤仅累及脉络膜者(6例),采取内切除(玻璃体切除)术式;肿瘤累及睫状体者(9例),采用外切除(经巩膜切除)联合玻璃体切除术式。随访1~9年,9眼(60%)的最佳矫正视力与术前相同或提高。6眼(40%)的最佳矫正视力低于术前,视力下降的主要原因为视网膜脱离和增生性玻璃体视网膜病变。15眼均无肿瘤复发,1眼(6.7%)因新生血管性青光眼最终行眼球摘除术。结论内切除或外切除联合玻璃体切除术是完整摘除葡萄膜神经源性肿瘤,保存视力的有效术式,同时尽可能降低了肿瘤医源性播散的可能。
Objective To study the surgical methods and long-term postoperative effects of uveal neurogenic tumors. Design retrospective case series. Participants Fifteen patients (15 eyes) with uveal neurogenic tumors undergoing partial tumor resection in Beijing Tongren Hospital from 1999 to 2011 were included. Methods To observe and record the patients’ preoperative clinical features, surgical methods, postoperative effects and histopathological examination. The main indicators of preoperative visual acuity, tumor location and size, postoperative visual acuity, complications. Results Among the 15 patients, 7 were ciliary body tumors (46.7%), 2 were ciliary body choroidal tumors (13.3%) and 6 were choroidal tumors (40%). Histopathological examination: 10 schwannomas, 4 gliomas and 1 neurofibroma. Tumors only involved the choroid (6 cases). Endoscopic resection (vitrectomy) was performed. Tumors involving the ciliary body (n = 9) were treated with excision (sclerectomy) and vitrectomy. The follow-up of 1 to 9 years, 9 (60%) of the best corrected visual acuity and preoperative the same or increased. The best corrected visual acuity in 6 eyes (40%) was lower than preoperative, the main reason for decreased visual acuity was retinal detachment and proliferative vitreoretinopathy. No tumor recurrence was seen in 15 eyes, and 1 (6.7%) was finally enucleated due to neovascular glaucoma. Conclusions Internal resection or excision combined with vitrectomy is an effective procedure for complete removal of uveal neurogenic tumors and preservation of visual acuity, while minimizing the possibility of iatrogenic dissemination of tumors.