目的:观察125I粒子植入治疗泪腺恶性肿瘤和复发的多形性腺瘤的临床效果和并发症.方法:回顾性系列病例研究.收集2008年7月至2016年2月于郑州大学第一附属医院眼科收入院治疗并保留完整病历资料的泪腺上皮性肿瘤16例,其中泪腺腺样囊性癌8例,黏液表皮样癌1例,癌在多形性腺瘤中2例,复发的多形性腺瘤5例.所有患者均经过手术和病理检查确诊,恶性肿瘤和复发的多形性腺瘤在术后1个月行125I粒子植入治疗. 临床和影像学检查随访项目包括肿瘤局部控制情况和并发症. 结果:①肿瘤控制情况:11例1次125I粒子植入有效控制病变;3例2次植入有效控制病变;1例3次、1例4次植入有效控制病变.②并发症情况:16例均未见眼球、视神经和颅脑穿刺损伤;13例在3个月内出现眼表刺激征,其中1例眼睑浅部植入粒子出现重度刺激征;8例出现干眼症表现;6例出现轻度的结膜充血、睑缘肥厚、睫毛或眉毛脱落、角膜水肿、角膜上皮脱失;4例出现皮肤表面红肿和色素沉着.并发症多在3个月后逐渐缓解和恢复正常.结论:泪腺恶性肿瘤和复发的多形性腺瘤,术后给予125I粒子植入内照射治疗,肿瘤局部控制效果好,且并发症较少,被认为是治疗易复发的泪腺上皮性肿瘤的有效方法.%ABSTRACT Objective: To observe the clinical effects and complications of 125I plaque brachytherapy for malignant tumors and recurrent pleomorphic adenomas of the lacrimal gland. Methods: In this restrospective case series study, 16 cases with lacrimal gland epithelial tumors were treated and followed up from July 2008 to February 2016 in the First Affiliated Hospital of Zhengzhou University. There were 8 cases with adenoid cystic carcinoma, 5 cases with recurrent pleomorphic adenoma, 2 cases with carcinoma in a pleomorphic adenoma, and 1 case with mucoepidermoid carcinoma. All patients were treated by surgery, and a pathological diagnosis for each was made. An 125I plaque was implanted one month after surgery. The clinical curative effects and radiation complications were observed. Results: Curative effect: Local recurrences were controlled effectively in all 16 patients, with 11 cases receiving one 125I plaque implantation, 3 cases receiving two implantations, 1 case receiving three implantations, and 1 case receiving four. Complications: In all 16 cases, there was noinvasive injury to the globe, optic nerve, or brain. Ocular surface irritating symptoms and signs were present in 13 cases within 3 months, among them, one case the surface irritation was severe. There were 8 cases with xerophthalmia, and 6 cases each had mild conjunctival hyperemia, pachyblepharon, lost eyelashes or eyebrows, corneal edema, or corneal epithelial loss. Four cases had skin stigmata and chromatosis. Some of the complications were gradually relieved after 3 months. Conclusions: 125I plaque implantation for treating malignant tumors and recurrent mixed tumors of the lacrimal gland was effective as a local tumor control with few complications. It is recognized as an effective method for treatment of recurrent lacrimal epithelial tumors.
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