方法：采用回顾性方法分析2007-01/2013-11的74例眼眶海绵状血管瘤患者。术前经CT或MRI联合彩色多普勒检查确诊。手术全部采用结膜入路，鼻下、颞下及正下方肿瘤采用下穹窿结膜切口，颞上象限的肿瘤采用颞侧结膜入路，鼻上及上方肿瘤采用内上方穹窿结膜入路，暴露后钳夹肿瘤，轻轻挽出瘤体； 如肿瘤与周围组织粘连紧密，则采用分步切除的方法：先切除部分瘤体，然后直视下再切除残留的肿瘤。

结果：74例海绵状血管瘤的术前确诊率达到100%。肌锥内58例(78%)，肌锥外16例(22%)，其中颞上方12例(16%)，上方16例(22%)，鼻下、颞下方及正下方46例(62%)，肿瘤直径8～59mm，手术全都采用结膜入路，其中下穹窿结膜入路46例，颞侧结膜入路12例，鼻上方结膜入路16例，有9例患者采取先摘除1/3瘤体，瘤体缩小后，再摘除剩下的肿瘤。8例患者术后视力下降，其中6例术后半年视力恢复。5例患者术后视力提高，术后无眼球突出，球结膜充血水肿10例，1例患者术后瞳孔不等大，复视6例。

结论：经结膜入路手术切除肿瘤适用于除眶尖部以外的所有眼眶海绵状血管瘤，结合直视下分步切除肿瘤法，可有效降低手术风险，提高手术安全性。

METHODS: We retrospectively analysed 74 patients with orbital cavernous haemangiomas between January 2007 and December 2013. Cavernous hemangioma was diagnosed preoperatively by computed tomography(CT)or magnetic resonance imaging(MRI)combined with color Doppler. Patients were underwent conjunctival approach, tumors located in the inferior, inferior lateral, or inferomedial sector using inferior fornix conjunctival incision, tumors located in super-lateral sector using the lateral conjunctival incision, tumors located in the superior and inferomedial sector using the super-nasal fornix conjunctival incision. Following exposure, the tumor was clamped and slowly pulled out. Careful dissection is necessary in case where tight adhesions are present.

RESULTS: The tumors were confirmed to be cavernous hemangiomas, consistent with preoperative diagnosis in 100%. Intraconal location was found in 58(78%), 16(22%)cases were in extraconal, including 12(16%)cases located in superlateral sector, 16(22%)cases located in superiormedial or superior sector, interior, inferiorlateral, or inferior locations occurred in 46(62%)cases. The tumor was 8mm to 59mm in diameter. All cases were underwent conjunctival approach, including 46 patients underwent inferior fornix conjunctival incision, 12 patients underwent lateral conjunctival incision, the supernasal fornix conjunctival incision was used on 16 cases. Nine patients were resected one third of the tumor firstly, then removed the rest. In 8 patients in visual acuity worsened postoperatively, 6 of them recovered after 6mo. Five patient's visual acuity improved. No patient had any residual proptosis,chemosis was occurred in 10 patients. One patient had unequal pupils as a result of a lesion of the ciliary nerve. Diplopia was spontaneously in all 6 patients in whom ocular movements were limited preoperatively, there was no diplopia in the other 68.

CONCLUSION: The transconjunctival approach of the tumor is suitable for all other than the tumour in the orbital apex, resect the whole tumor in a fractional resection way under orthophoria can effectively reduce the operation risk and improve operation safety.