目的:鼻窦恶性肿瘤的可能风险之一是其可能在眼眶中扩散。然而,对于是否有必要在眼眶周围脂肪有限的肿瘤浸润中切除眼眶,不同部门之间没有明确的共识。该研究的目的是证明,在不涉及较深的眼眶组织的情况下,眶周浸润和眶周脂肪浸润不是眶切除术的指征。
方法:对接受手术治疗的鼻窦恶性肿瘤患者进行了17年的回顾性分析,这些患者在组织学上证实了眶周浸润或更深地侵入了眼眶。共有32名患者被纳入研究。对于每个小组,分析了以下数据:性别,年龄,术前影像学研究,组织学发现,产地,舞台,外科重建,肿瘤治疗,生存,死因,眼眶内复发的次数和保留眼睛的功能状态。
结果:根据我们的眼眶切除标准,18例患者的眼眶保留是可行的。对14例肿瘤浸润较深的患者进行了眼眶切除术。两组之间的生存差异有统计学意义。眼眶保留组(仅2例死于局部肿瘤复发)的5年总生存率(OS)为44%,眼眶切除术组为34%。除眼眶浸润程度外,两组在其他观察到的因素上没有差异。在11名(61.1%)患者中,放射治疗后视力无明显变化.在2例(11.1%)患者中,复视导致视觉功能受损。5例(27.8%)患者放疗后视神经萎缩导致视力严重受损。
结论:我们的结果表明,保留眼眶的患者组的生存率相对较高,视力保留的机会很高,这证明了我们的方法,即使在一些有眶周浸润的肿瘤中也是如此。
OBJECTIVE: One of the possible risks of sinonasal malignancy is its possible spread in the orbit. However, there is no clear consensus among the different departments as to whether it is necessary to exenterate the orbit in limited tumorous infiltration of periorbital fat. The purpose of the study was to demonstrate that periorbital infiltration and periorbital fat invasion without involvement of deeper orbital tissues are not the indication of orbital exenteration.
METHODS: Retrospective analysis was performed over a 17-year period of patients undergoing surgical treatment for sinonasal malignancy with histologically verified periorbital infiltration or deeper invasion into the orbit. A total of 32 patients were included in the study. For each group, the following data were analysed: sex, age, preoperative imaging studies, histological findings, site of origin, stage, surgical reconstruction, oncological treatment, survival, cause of death, number of recurrences in the orbit and functional status of preserved eyes.
RESULTS: Based on our criteria for orbital exenteration, orbital preservation was feasible in 18 patients. Orbital exenteration was performed in 14 patients with deeper tumor infiltration. There was a statistically insignificant difference in survival between the two groups. The 5-year overall survival (OS) was 44% for the orbital preservation group (only 2 patients died from local tumor recurrence) and 34% for the orbital exenteration group. The groups did not differ in other observed factors other than the extent of orbital infiltration. In 11 (61.1%) patients, vision was without significant change after radiation therapy. In 2 (11.1%) patients, visual function was impaired due to diplopia. 5 (27.8%) patients had severely impaired vision due to optic nerve atrophy after radiation therapy.
CONCLUSIONS: Our results show a relatively high survival rate in the group of patients with orbital preservation with a high chance of vision preservation, which justifies our approach to orbital preservation even in some tumors with periorbital infiltration.