Hughes変法による悪性眼瞼腫瘍の治療

Treatment of malignant eyelid tumor by modified Hughes procedure

要約　目的：眼瞼の悪性腫瘍に対するHughes変法の記述と成績の報告。対象と方法：上または下眼瞼の50％以上の全層切除が必要と判断された12例を対象とした。男性と女性ともに6例で，年齢は60～92歳（平均73歳）である。上眼瞼が4例，下眼瞼が8例で，全例で生検が行われ，脂腺癌10例，基底細胞癌1例，粘表皮癌1例である。腫瘍を切除した後に，瞼板と結膜弁（Hughes flap）および周囲の眼瞼皮膚の伸展皮弁で眼瞼を再建した。4～5週後にflapを切り離し，瞼縁組織をトリミングした。結果：瞼板と結膜弁に血行不全が生じた例はなく，平均18.3か月の観察期間中に再発または転移はなかった。整容的にも良好な結果が得られた。結論：眼瞼の悪性腫瘍に対するHughes変法は，侵襲が小さく，合併症が少ない。下眼瞼だけでなく，上眼瞼の腫瘍にも応用できる。

Abstract.　Purpose：To report the outcome of surgery for malignant eyelid tumor by modified Hughes procedure. Cases and Method：This study was made on 12 cases of eyelid malignancy that needed total resection of more than 50％ of upper or lower eyelid. The series comprised 6 males and females each. The age ranged from 60 to 92 years,average 73 years. The tumor was located in the upper eyelid in 4 cases and in the lower eyelid in 8 eyes. After resection of the tumor,the defect is reconstructed by tarsoconjunctival flap,or Hughes flap,and by stretching the surrounding skin of the eyelid. The pedicle is divided after 4 or 5 weeks to create the eyelid margin. Results：No case developed ischemia or necrosis of tarsoconjunctival flap. There was no recurrence or metastasis during the follow-up for an average of 18.3 months. Functional and cosmetic outcome were satisfactory in all the cases. Conclusion：Modified Hughes procedure is less invasive and results in lesser complications for eyelid malignancy. It can be applied to tumor of the lower as well as upper eyelid.