目的 总结和分析结膜乳头状瘤患者的临床特点、其与人乳头瘤病毒(HPV)感染的关系以及手术联合药物治疗后复发情况.方法 回顾性系列病例研究.收集2008年1月至2018年6月于北京协和医院眼科就诊的经病理检查确诊为结膜乳头状瘤的40例(41只眼)患者的临床及随访资料.所有患者均进行血常规、尿常规、乙型肝炎病毒表面抗原、丙型肝炎病毒抗体、人类免疫缺陷病毒抗体、梅毒螺旋体抗体、尿道脱落上皮HPV的检测;手术切除术中避免器械直接接触肿物并且联合冷冻等;肿物切除后均行组织病理学检查、瘤体HPV检测;术后联合多种药物治疗并记录复发情况.结果 40例(41只眼)患者中男性22例(23只眼),女性18例(18只眼);肿瘤单发27只眼,肿瘤多发14只眼.无蒂型乳头状瘤见于老年患者(年龄＞50岁,13例,13只眼),有蒂型乳头状瘤多见于青年患者(年龄12～40岁,27例,28只眼).40例患者肿瘤组织病理主要表现为结膜上皮组织呈乳头状增生的良性肿瘤,其中9例发现鳞状上皮细胞呈中-重度不典型增生.40例结膜乳头状瘤患者中17例肿瘤和(或)尿道脱落上皮PCR检测HPV呈阳性(占42.5％),16例患者尿常规结果显示有白细胞升高并且潜血阳性(占40.0％).40例患者中首诊初发患者33例,复发患者7例,所有患者行联合治疗后随访(37.4±11.9)个月,患者均未复发.结论 结膜乳头状瘤多发于20～40岁青年人以及＞50岁的老年人,且多单眼发作;个别患者肿瘤合并鳞状上皮细胞不典型增生;其发病可能与HPV感染、尿路感染有关;联合治疗能够降低复发率.%Objective To summarize and analyze the clinical manifestation of conjunctival papilloma,its relationship with human papillomavirus (HPV) infection and the recurrence after the combination of operation and pharmacotherapy.Methods A retrospective case series study.Analysis of 40 patients (41 eyes) with conjunctival papilloma treated at Peking Union Medical College Hospital from January 2008 to June 2018 was performed.All patients were given routine blood and urine,hepatitis B virus surface antigen,antibodies to hepatitis C virus,antibodies to human immunodeficiency virus and antibodies to Treponema pallidum testing,and HPV testing for the urethra epithelial tissue.Direct contact of the tumor with instruments was avoided during surgery,and freezing treatment was combined.HPV testing was performed for the resected conjunctival papilloma.Multiple medications were used after surgery.Results In 40 cases with 41 eyes,there were 22 males (23 eyes) and 18 females (18 eyes).A single tumor was seen in 27 eyes,and multiple tumors were seen in 14 eyes.Thirteen patients (13 eyes) older than 50 years old had pedicel-free papillpma,and 27 patients (28 eyes) aged from 12 to 40 years had pedicel-type papillpma.All cases were confirmed by pathology as conjunctival papilloma,of which 9 cases showed moderate to severe atypical hyperplasia on squamous cells.The HPV test was positive in 17 out of the 40 cases (42.5％) of conjunctival papilloma.Urine test results of 16 patients (40.0％) were positive for occult blood and showed that urinary white blood cell was elevated.Of the 40 patients,33 were newly diagnosed and 7 had a relapse.The average follow-up time was (37.4± 11.9) months after combined therapy and no recurrence was found in any patients.Conclusions Conjunctival papilloma is usually observed in people aged from 20 to 40 years and older than 50 years,and it often occurs in one eye.Its main pathological featureis benign tumors of the papillary hyperplasia on the conjunctival epithelial tissue.Some patients haveatypical hyperplasia of squamous cells.The cause of the disease may be related to the infection of HPV andthe urinary tract.Combined treatment can reduce the recurrence rate of conjunctival papilloma.
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