摘要目的 总结眼睑恶性肿瘤手术切除后一期重建方法的综合应用并评估其长期疗效.方法 回顾性病例研究.2005年至2008年于复旦大学附属眼耳鼻喉科医院住院手术的46例眼睑恶性肿瘤患者的临床资料,并对患者的一般情况,肿瘤的性质、部位、侵犯程度,以及手术的类型,术后外观,患者舒适度,生存率等进行分析、评估.结果 眼睑前层缺损采用了各种皮片移植术、皮瓣滑行术、半圆形旋转皮瓣术、Glabellar瓣等方法修补,后层缺损采用了Hughes瓣、自体睑板移植、自体硬腭黏膜移植等方法修补,单独或综合采用各种眼睑重建技术.平均随访(59.7±12.9)个月(15～84个月).5年、7年的生存率分别为94％、91％.2例出现轻度的眼睑内、外翻,1例出现下睑倒睫,其余患者眼睑位置正常.87％的患者对外观和舒适度满意.结论 综合采用眼睑重建技术为眼睑恶性肿瘤手术的一期重建奠定了基础,并取得了较好的疗效.但密切的临床随访不容忽视.

abstractsObjective To review the management of malignant eyelid tumors with primary reconstruction and the long-term outcomes.Methods Retrospective case study.The data from 46 eyes with malignant eyelid tumors were analyzed in patients who had undergone surgical excision from 2005 to 2008 in Shanghai Eye and ENT Hospital.The cancer type,location,extension,type of the procedure,appearance after surgery,comfort level and survival rate were evaluated.Results Among 46 cases,basal cell carcinoma (21 cases),sebaceous gland carcinoma (19 cases),squamous cell carcinoma (4 cases),lymphoma (1 cases) and Merkel cell carcinoma (1 case) were included.Various techniques were used,such as the Hughes procedure,Cutler-Beard reconstruction,myocutaneous advancement flap,semicircular rotational flap,lateral cantholysis,periosteal strip,free autogenous tarsal graft,full-thickness skin graft,glabellar flap,et al.Median follow-up was 59.7±12.9 months (15-84 months).According to the Kaplan-Meier survival estimate,the overall five-year and seven-year survival rates were 94％ and 91％,respectively.The five year tumor-free survival rate was 91％.During the follow-up period,local recurrence occurred in two patients who refused further treatment and they were still alive at the last follow-up.Cervical lymph node enlargement was detected in two cases,followed by lymph node debridement.Both of them were in good condition until now.Four patients died,two of metastasis,one of old age,and one of primary esophageal carcinoma.Conclusion Eyelid reconstruction techniques can effectively repair defects after resection of malignant eyelid tumors and lead to satisfactory clinical results.Active surveillance is still mandatory.