作者：吴国海，何光辉，余晓梅 作者单位：宁波市江东眼科医院，浙江 宁波 315040
【摘要】 目的 临床分析60例眼眶疾病的手术疗法并总结经验。方法 对60例（60眼）眼眶病患者（其中眼眶肿瘤49例，爆裂性骨折5例，眼眶内异物6例）根据病因及病变位置选择不同的手术入路，进行手术治疗，术后半年观察视力及外观变化。结果 肿瘤完整取出者45例，肿瘤囊内取出、囊袋完整摘除或肿瘤部分摘除者3例，肿瘤未取出者1例。异物完整取出者6例。5例骨折患者medper在位，眼球凹陷完全矫正者4例，残留2 mm者1例。术后视力无变化者59例，术后视力丧失者1例；上睑下垂者1例。结论 术前应行必要的影像学检查并详细分析检查结果，选择最佳手术入路。充分估计手术的风险和可能出现的并发症，制定周密的手术方案，与患者进行有效的沟通。尽量在直视下进行手术操作，控制术中的出血。密切监测瞳孔的状态。术后做好引流措施及常规进行视力监测。
【关键词】 眼眶；外科手术；临床分析
Clinical analysis of sixty cases of orbital surgery
WU Guohai， HE Guanghui， YU Xiaomei.
Ningbo Jiangdong Ophthalmology Hospital， Ningbo China， 315040
［Abstract］Objective Clinical analysis of 60 cases of orbital disease treated with surgery and a summary of the treatment effects of different surgical methods. Methods Sixty cases (60 eyes) of orbital disease (49 cases of orbital tumors， 5 cases of blowout fracture， 6 cases of orbital foreign body) were treated with different surgical methods according to the pathology. Postoperative visual acuity and appearance changes were assessed 6 months after surgery. Results Forty-five cases of tumors were completely removed， 3 cases were partially removed， and 1 tumor was not removed. Foreign bodies were completely removed in all 6 cases. Visual acuity did not change in 59 cases； 1 case lost visual acuity postoperatively. Ptosis was found in 1 case. Conclusion Before surgery is performed， a necessary detailed analysis of imaging studies and test results should be made in the selection of the best surgical approach. Guidelines for successful surgery include： a complete estimation of the risks of surgery and possible complications， the development of a well-surgery program， effective communication with patients， performing surgery under direct vision， the control of intraoperative bleeding； close monitoring of the status of the pupil， good drainage measures and routine postoperative visual acuity monitoring.
［Key words］ orbit； surgery； clinical analysis
眼眶疾病不是眼科的常见病和多发病，诊断与治疗有其特殊性，而手术治疗往往是眼眶疾病特别是眼眶肿瘤去除病灶、明确诊断、保留视功能、改善外观的唯一办法。本研究对60例各类眼眶疾病的治疗过程及结果进行分析并总结经验如下。
1 资料和方法
1.1 资料
收集 2004年4月至 2009年3月在我院行眼眶手术的患者60例（60眼），其中男29例，女31例，年龄2~84岁，平均（49.4±19.8）岁。其中，眼眶肿瘤49例，爆裂性骨折5例，眼眶内异物6例。
1.2 方法
1.2.1 全部病例术前均经必要的医学影像（B超、CT、MRI）检查明确诊断。
1.2.2 手术方法
手术在全麻或局麻下进行，经皮前路开眶者22例，经典外侧开眶或改良外侧开眶者18例，爆裂性骨折整复手术者5例，其他切口者15例。开眶后分离周围组织及脂肪，充分暴露肿瘤、异物或骨折处，摘除肿瘤或异物或用高密度聚乙烯聚合物材料（MEDPER）修复骨折处。术中随时观察瞳孔的变化。
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