目的：分析不同手术入路治疗眼眶肿瘤的临床效果。

方法：我院眼科2012-01/2017-06收治的眼眶肿瘤患者52例56眼均行颅脑核磁共振(MRI)及眼眶计算机断层扫描(CT)明确肿瘤与周围解剖结构的关系，并行开眶手术治疗，入路方式包括经结膜入路前路开眶术、外侧开眶术、内外侧联合开眶术，统计所有患者肿瘤切除情况、视力恢复情况、术后早期并发症以及随访复发情况。

结果：本组52例患者中有7例8眼(14%)肿瘤残留，经结膜入路前路开眶术肿瘤残留率(23%)高于外侧开眶术、内外侧联合开眶术(6%、7%)，差异均有统计学意义(P<0.05)。本组患者视力提高者28例30眼(54%)、无变化者18例19眼(34%)、下降者6例7眼(13%)； 早期并发症发生率为23%，包括意外视力丧失2例2眼、瞳孔改变2例2眼、上睑下垂3例3眼、眼动障碍5例6眼，主要集中发生于老年患者； 三种手术入路视力恢复情况、并发症发生率(23%、19%、29%)接近，差异均无统计学意义(P>0.05)。随访期内，52例患者中有3例3眼(5%)复发，内外侧联合开眶术术后复发率(14%)明显高于经结膜入路前路开眶术、外侧开眶术(4%、0)，差异均有统计学意义(P<0.05)。

结论：选择合适的手术入路可成功摘除眼眶肿瘤、改善或稳定视功能、减少手术并发症和复发情况。

METHODS: A total of 52 patients(56 eyes)with orbital tumors who were admitted to the hospital from January 2012 to June 2017 were examined by brain MRI and orbital sectional CT scan to identify the relationship between tumors and surrounding anatomical structures. They were treated by orbitotomy, and the approaches included anterior conjunctival approach, lateral approach and combined medial and lateral approach. The removal of tumors, recovery of visual acuity, postoperative early complications and follow-up recurrence were statistically analyzed.

RESULTS: Among the 52 patients, there were 7 cases 8 eyes(14%)with residual tumors. The rate of residual tumors after anterior conjunctival orbitotomy(23%)was higher than that after lateral orbitotomy or combined medial and lateral orbitotomy(6%, 7%; P<0.05). The visual acuity was improved in 28 cases 30 eyes(54%), no change in 18 cases 19 eyes(34%)and decreased in 6 cases 7 eyes(13%). The incidence of early complications was 23%, including 2 cases 2 eyes with accidental loss of vision, 2 cases 2 eyes with pupil changes, 3 cases 3 eyes with ptosis and 5 cases 6 eyes with eye movement disorders, which mainly occurred in the elderly. The recovery of visual acuity and the incidence rates of complications(23%, 19%, 29%)of the three kinds of surgical approaches were close(P>0.05). During the follow-up period, there were 3 cases 3 eyes(5%)with recurrence in the 52 patients, and the recurrence rate after combined medial and lateral orbitotomy(14%)was significantly higher than that after anterior conjunctival or lateral orbitotomy(4%, 0; P<0.05).

CONCLUSION: The appropriate surgical approach can successfully remove the orbital tumors, improve or stabilize the visual function, and reduce complications and recurrence.