Hughes方法修复恶性肿瘤切除术后下睑全层缺损

摘要

目的 评估Hughes方法修复恶性肿瘤切除后下睑全层缺损的临床效果.方法 回顾性系列病例研究.收集北京同仁眼科中心2008年6月至2013年5月确诊下睑恶性肿瘤的157例患者的临床资料,对其中采用Hughes方法修复肿瘤切除后下睑缺损病例进行回顾性分析.肿瘤切除采用术中冰冻切片监控法,肿瘤切除后下睑全层缺损范围达到50％ ～ 80％.利用Hughes方法修复下睑后层缺损,局部皮瓣及游离皮片法修复下睑前层缺损.术后1～3个月行睑裂切开及睑缘修复术.结果 在157例下睑恶性肿瘤中位于前3位的是基底细胞癌(107/157,68.2％)、皮脂腺腺癌(32/157,20.4％)和恶性黑色素瘤(10/157,6.4％).采用Hughes手术方法者共有21例患者(年龄43 ～77岁)21只眼,随访8～ 60个月,无肿瘤复发,仅1例鳞癌腮腺转移,手术切除.所有病例远期下睑形态良好,上睑无成角畸形、无上睑退缩或内翻.并发症包括早期轻度下睑退缩3例和暂时性下睑外翻1例,未予再次手术;下睑内翻2例,经再次手术矫正.结论 采用Hughes方法修复下睑恶性肿瘤切除术后下睑后层缺损,可取得良好的功能重建和美容效果.%Objective To evaluate surgical outcome of reconstruction of full-thickness lower eyelid defect resulting from tumor excision.Methods A retrospective case series review of patients with lower eyelid malignant tumor who underwent surgical repair of full-thickness eyelid defect from June 2008 to May 2013 was made.The defect ranged from 50％ to 80％ of the lower eyelid after excision of tumor with frozen section control of the surgical margins.Hughes technique was used to reconstruct the posterior lamellar and local flap and free graft were fashioned to repair the anterior defect.The pedicle was divided at 1-3 months postoperatively.Results Of the 157 lower eyelid malignant tumors,the 3 most common types were basal cell carcinoma (107/157,68.2％),sebaceous gland carcinoma (32/157,20.4％),and malignant melanoma (10/157,6.4％).Twenty-one eyelids of 21 patients (aged from 43 to 77 years old) were identified.No tumor recurred during follow-up period (8-60 months).There was only one case with squamous carcinoma metastasized to the parotid gland and then excised.The contour of all lower eyelids was satisfactory.No eyelid margin deformity or upper lid retraction was observed.Revision surgery was performed to treat lower lid entropion (3 patients),while mild lower lid retraction (2 patients) and temporary ectropion (one patient) required no management.Conclusion Hughes flap,which is a posterior lamellar replacement for lower eyelid defect after removal of malignant tumor,achieves favorable functional and cosmetic results.