目的 分析视网膜母细胞瘤患儿施行眼球摘除术的心理护理措施,为眼球摘除术提供护理保障.方法 选择该院眼科2015年3月至2019年12月收治的23例视网膜母细胞瘤并施行眼球摘除术的患儿为研究对象,总结护理配合中有效的护理措施.结果 23例全身麻醉下施行眼球摘除术的患儿均治愈出院,未发生术后感染及手术并发症.随访1～4年,其中1例患儿视网膜母细胞瘤复发后发生颅内转移,经治疗无效死亡,其余患儿无复发.结论 做好患儿及患儿家长的心理护理及优质的手术配合,可有效减轻患儿及家长的心理负担,保证患儿手术和麻醉安全,提高手术效率.

Objective To investigate the characteristics of clinical treatment and prognosis of 118 cases of retinoblastoma (RB). Methods A total of 118 RB children treated in our department from February 2008 to February 2018 were recruited in this study. All of them were evaluated by the International Classification for Intraocular Retinoblastoma (IIRC, A~E stage) and extraocular staging standard. Mainly according to their tumor stage, combined with their physical condition and the wishes of their parents, treatments such as intravenous chemotherapy, transpupillary thermotherapy (TTT), freezing and enucleation were applied. All cases were followed up for 1 to 10 years, and the clinical efficacy and prognosis of the patients were analyzed retrospectively. Results The 118 enrolled children (154 eyes) were 70 males and 48 females, at an average age of 25.94±20.88 months (1~122 months) at first visit, and 36 of them suffered from bilateral RB and 82 from single. Among them, 41 received chemotherapy, 57 chemotherapy combined with TTT, 10 chemotherapy combined with freezing, and 10 enucleation only. After treatment, 76 eyes (76/154) were salvaged, with a total salvage rate of 49.35%, and of them, 47 eyes were treated with chemotherapy combined with TTT, accounting for 61.84% (47/76). Seventy-eight eyes were enucleated, with a total extraction rate of 50.65% (78/154), and among 63 eyes at stage E, 53 were enucleated, accounting for 84.13%. During the mean follow-up time of 86.66±5.69 months, 22 (18.64%) children died, and 96 cases (81.36%) survived. The 5-year cumulative survival rate of single eye was 71.40%, and of bilateral was 80.00%. Conclusion Intravenous chemotherapy combined with TTT is one of the main ways for RB salvage. Enucleation is still the primary treatment for stage E eyes.

患儿女性,2岁. 因"左眼不能上转1年余"入院. 眼科查体:视力不合作,右眼外眼正常,左眼下睑内翻倒睫,左眼球内下转,眼球稍突出,眼球上转、外转受限,上方结膜充血明显,余窥不入(图1). 眼眶CT检查(图2)示左眼球改变,左眼球后上方囊性改变,双侧上颌骨前方未骨性融合,考虑唇裂. 脑室系统扩张. 拟诊:(1)左眼眶肿瘤;(2)先天性唇腭裂. 入院后全麻下行左眼球摘除+左眼眶肿瘤切除+眶减压术. 术中(图3)见眼球一个,前后径1. 8 cm,左右径2. 1 cm. 视神经长约3 cm,于其上可见一囊性包块,大小约3. 8 cm × 2. 5 cm × 2 cm,切开囊内有清亮液体流出,囊壁厚约0. 1cm. 术后组织病理学检查示左眼球球壁视网膜内局部查见增生的视网膜,结构紊乱,伴少量纤维及血管增生,另见包绕视神经的囊肿,囊肿壁由纤维结缔组织及视神经的成分构成;符合视神经囊肿. 诊断:(1)左侧视神经囊肿;(2)左眼球萎缩;(3)先天性唇腭裂.

Objective To observe the clinical effect of transsphenoidal approach for decompression by nerve endoscopy in traumatic optic neuropathy.Methods Clinical data of 19 patients diagnosed as having optic nerve injury in Department of Ophthamology ,Daping Hospital from Nov.2014 to Dec.2016 were analyzed retro-spectively.All of them were male,aged 10～63 years,with an average of 30 years.Preoperative vision was as fol-lows: 7 cases of no light sensation,4 cases of light sensation,5 cases of manual sensation,and 3 cases of finger counting.All patients were treated with methylprednisolone for 500mg and did not improve their eyesight with meth-ylprednisolone treatment.All these patients were treated by transsphenoidal approach for decompression under nerve endoscopy.Decompression range was based on the length of optic canal measured by CT.The clinical therapeutic efficacy and the postoperative visual acuity of these patients were observed and analyzed for 6 months of follow-up. Results Clinical symptoms improved in 11 of the patients after surgery ,with a total efficacy of 57.9%.Of 7 pa-tients who had no light perception ,2 cases (2 eyes) got better after operation ,and the rate of visual acuity improve-ment was 28.6%.Nine patients (9 eyes) in the 12 patients with light perception before operation had improved vi-sion after surgery,with the rate of visual acuity improvement of 75%.The best visual acuity was 0.12.One patient had cerebrospinal fluid leakage after surgery and healed after conservative treatment .No nasal bleeding or paranasal sinusitis occurred.Nineteen patients had no significant changes in visual acuity after six months of follow -up.Con-clusion Transsphenoidal approach for decompression by nerve endoscopy is effective in improving the visual acuity in optic nerve injury patients with minimal invasiveness and few complications ,thus worth of option.

AIM:To perform a new method for orbital implant and contracted socket through one time and its results. ·METHODS:Totally 114 patients 114 eyes, from January 2008 to June 2014, with contracted socket participated in this study. We incised the bulbar conjunctiva horizontally and excised scar tissue, then implanted the hydroxyapatite in the four extraocular muscles and tightly sutured the Tenon ' capsule. After that, we put the superior and inferior conjunctival petals backwards and sutured them to the Tenon ' s capsule. All the patients were divided into four groups according to the vertical diameter length of the conjunctival defect area:GroupⅠ:≤5mm; Group Ⅱ: 6-10mm; Group Ⅲ: 11-15mm; and Group Ⅳ: ≥16mm. These patients were followed up for 6mo to 3y to observe the conjunctival sac shaping and growth of conjunctiva. ·RESULTS:There were 64 cases in GroupⅠ, 31 cases in Group Ⅱ, 16 cases in Group Ⅲ and 3 cases in Group Ⅳ. All patients ' conjunctival defect was covered by new conjunctiva and scar tissue 4 to 6wk after surgeries. Ten cases had contracted socket; 2 cases had orbital implant exposure, requiring reoperation. Of the 114 cases, 8 had contracted socket and could use a smaller conformer, 106 could use a normal size conformer. ·CONCLUSION: When the conjunctival defect was ≤15mm, this new method can address the orbital implant and contracted socket at the same time. While it was ≥16mm, flap transplantation is necessary.

AlM: To remove orbital cavernous hemangioma by transconjunctival approach, and to examine efficacy and complications of this approach.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 ( MRl ) 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%. lntraconal 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. ln 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.CONCLUSlON: 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.

目的:探讨减少化学减容治疗视网膜母细胞瘤的化疗反应,使视网膜母细胞瘤患儿能顺利完成化疗。方法:通过应用建立良好的护患关系、做好患儿和家长的心理指导、静脉通道的维护、VEC化疗药物的护理等方法对我科2010年4月～2011年5月收治的16例患儿90例次化疗进行护理。结果:16例患儿均顺利完成化疗。结论:通过有效的护理措施,减少了化学减容治疗视网膜母细胞瘤的化疗反应,使视网膜母细胞瘤患儿能顺利完成化疗。