• 四川大學(xué)華西醫(yī)院眼科（成都，610041）;

【摘要】　目的　 探討結(jié)膜惡性黑色素瘤的手術(shù)治療方法。　方法　 1997年1月-2007年1月收治結(jié)膜惡性黑色素瘤48例，均為單眼。腫瘤范圍: lt;1/3眼瞼長度及結(jié)膜14例， gt;1/3眼瞼長度，部分穹隆結(jié)膜受累19例，上下眼瞼及內(nèi)外眥大部分結(jié)膜受累者15例。采用單純腫瘤切除術(shù)、單純腫瘤切除聯(lián)合液氮冷凍治療、眼眶內(nèi)容物剜除術(shù)3種治療方法。　結(jié)果　 所有患者均經(jīng)病理學(xué)證實為結(jié)膜惡性黑色素瘤 。術(shù)后48例進行9個月～5年隨訪，15例眶內(nèi)容物剜除術(shù)，3例死于肺及顱腦轉(zhuǎn)移；14例單純擴大腫瘤切除聯(lián)合液氮冷凍治療，2例死于肝轉(zhuǎn)移；19例單純擴大腫瘤切除術(shù)，6例分別死于肝、肺及顱腦轉(zhuǎn)移。　結(jié)論　 早期診斷并選擇積極有效的手術(shù)治療是提高患者生存率，改善生存質(zhì)量的重要手段。手術(shù)切除聯(lián)合液氮冷凍法可有效降低腫瘤復(fù)發(fā)，避免影響患者視覺質(zhì)量和外觀，是治療結(jié)膜惡性黑色素瘤的一種有效方法。
【Abstract】　Objective　 To investigate the surgical therapeutics for malignant melanoma of eyelid conjunctiva.　Methods　 A total of 48 patients with monocular malignant melanoma of eyelid conjunctiva from January 1997 to January 2007 were collected. The scope of the melanoma involved  lt;1/3 eyelid length and conjunctiva in 14,  gt;1/3 eyelid length and part of conjunctival formix in 19, and upper and lower eyelid and most of the conjunctiva of medial and lateral canthus in 15. Eye socket exenteration,tumor resection combine with eyelid reconstruction, tumor resection were used.　Results　 All of the patients were diagnosed as malignant melanoma of eyelid conjunctiva by pathological examination. The follow-up period was 9 months-5 years. Among the 15 patients who had undergone eye socket exenteration,3 died. Among the 14 patients who had undergone expand tumor resection combine with liquid nitrogen frozen, 2 died. Among the 19 patients who had undergone tumor resection combine with eyelid reconstruction, 6 died.　Conclusion　 Tumor resection combine with liquid nitrogen frozen is effective on malignant melanoma of eyelid conjunctiva.

引用本文： 郭波,馬可,劉綺. 結(jié)膜惡性黑色素瘤的手術(shù)治療. 華西醫(yī)學(xué), 2010, 25(11): 2043-2045. doi: 復(fù)制

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  2. 2. 　Tuomaala S, Eskelin S, Tarkkanen A, et al. Population-based assessment of clinical characteristics predicting outcome of conjunctival melanoma in whites[J]. Invest Ophthalmol Vis Sci, 2002, 43 (11): 3399.
  3. 3. 　Shields CL, Shields JA, Gunduz K, et al. Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients[J]. Arch Ophthalmol, 2000, 118 (11): 1497.
  4. 4. 　余樹觀, 沙永慧. 頭頸部惡性腫瘤[M]. 河南: 河南科學(xué)技術(shù)出版社, 1990: 132-133.
  5. 5. 　Jakobiec FA. The ultrastructure of conjunctival melanocytic tumor[J]. Trans Am Ophthalmol Soc, 1984, 82: 599.
  6. 6. 　Jakobiec FA. The role of cryotherapy in the management of conjunctival melanoma[J]. Ophthailmology, 1982, 89: 502.
  7. 7. 　Stannard CE, Scaly RH, Hering ER, et al. Malignant melanoma of the eyelid and palpebral conjunctiva. treated with iodine-125 brachytherapy[J]. Ophthalmo logy, 2000, 107 (5): 951.
  8. 8. 　趙光璽. 眼部成形學(xué)[M]. 北京: 人民衛(wèi)生出版社, 1995: 65-66.
  9. 9. 　郭波, 羅清禮, 郭祥文, 等. 異體鞏膜移植替代瞼板重建眼瞼[J]. 中國修復(fù)重建外科雜志2003, 17(5): 403-405.
  10. 10. 　吳中耀. 眼腫瘤眼眶病學(xué)[M]. 北京: 人民軍醫(yī)出版社, 2002: 106-108.
  11. 11. 　Vaughhan D, Asbury T, Riiordan-Eva P. General Ophthalm-ology[M]. 15th ed. Prentice Hall Inernationnal, Inc. 1999, 116-117.