眼眶组织淀粉样变易误诊临床探析.docVIP

眼眶组织淀粉样变易误诊临床分析 　　[摘要] 目的 探讨眼眶组织淀粉样变临床特点及误诊原因，探讨其治疗方法。 方法 对西安市第四医院2009年1月～2016年1月收治的确诊为眼眶组织淀粉样变12例的临床资料进行回顾性分析，观察患者临床表现、误诊疾病、治疗情况及相关影像学资料。 结果 眼眶组织淀粉样变临床症状复杂，眼眶CT及MRI检查无特异性改变。8例误诊为眼眶炎性假瘤，3例误诊为血管瘤，1例误诊为眼睑恶性肿瘤。治疗结果：11例均尽量切除病变，1例病变范围太广，未能全切；术后随诊观察9例，1例放疗，2例进行全身激素治疗。大部分患者预后较好。 结论 眼眶组织淀粉样变临床无特征性表现，应依靠病理诊断，不同部位的肿瘤应根据病灶的特点选择合适的诊疗方案，手术应尽可能切除病变组织 [关键词] 眼眶组织；淀粉样变；误诊 [中图分类号] R777 [文献标识码] A [文章编号] 1673-7210（2016）10（c）-0118-04 [Abstract] Objective To evaluate the clinical characteristics and misdiagnosis reasons of orbital amyloidosis， to discuss the treatment methods. Methods The clinical data of 12 cases diagnosed as orbital amyloidosis admitted to Xi’an No.4 Hospital from January 2009 to January 2016 was analyzed retrospectively. The clinical features， misdiagnosed diseases， treatment situations and related imaging data were observed. Results The clinical symptoms of orbital amyloidosis were complex， the detection of orbital CT and MRI showed no specific changes. There were 8 cases misdiagnosed as orbital inflammatory artificial tumor， 3 cases misdiagnosed as orbital hemangioma， 1 case misdiagnosed as orbital malignancy. The results of treatment： 11 cases were given lesions resection as far as possible， 1 case failed to take full-cut because of wide lesion range； postoperative follow-up for 9 cases， 1 case took radiation， 2 cases took general hormone therapy. The prognosis of most patients was good. Conclusion The orbital amyloidosis has no characteristic clinical features， the diagnosis of which should depend on pathology， the tumors of different regions should choose appropriate diagnosis and treatment plan according to the characters of the lesions， the operation should cut lesion tissues as much as possible. [Key words] Orbital tissue； Amyloidosis； Misdiagnosis 淀粉样变性是指由于蛋白代谢障碍而出现一种生理上不存在的均质性蛋白性物质的疾病，是淀粉样物质在某些器官的网状纤维、血管壁或组织间沉着的一种病理过程[1]。淀粉样变性主要分为3种类型：原发性淀粉样变性、继发性淀粉样变性及家族遗传性淀粉样变性[1]。根据病变受累部位又分为全身性淀粉样变性和局限性淀粉样变性。病理组织学常规苏木精-伊红染色（HE）镜检：光镜下可见大片均质嗜伊红无定形物质沉积，呈结节状或弥漫分