Hughes法で下眼瞼を再建した眼瞼脂腺癌の1例

A case of sebaceous carcinoma in the lower eyelid reconstructed after Hughes method

　58歳男性の左下眼瞼マイボーム腺癌を経験した。他院にて霰粒腫として7か月間点眼薬を投与されていたが，治癒しないため来院した。腫瘍は眼瞼結膜面に露出し，大きさ12×9×4mmであったが，単純切除後2週間で大きさ10×8×3mmに再発し，病理組織検査でマイボーム腺由来の脂腺癌と診断した。術中迅速凍結病理検査管理下に，腫瘍を　25×13mm　で広範囲に切除，下眼瞼欠損部は内層をHughes flap （tarso-conjunctival flap），表層を左耳介後部からの全層遊離植皮により再建した（Hughes法）。術後20週目にflapを切断し開眼させ，眼瞼縁を形成した。術後11か月，再発や転移を認めず，機能的，美容的にも経過良好である。

A 58-year-old male presented with sebaceous carcinoma in the left lower eyelid. The condition had been treated as chalazion with topical antibiotics for 7 months before being seen by us. The tumor was 12×9×4 mm in size, elastic hard and was located in the middle of the eyelid. Small nodules with smooth surface and dilated vessels were exposed on the tarsal conjunctiva. Diagnostic simple excision showed the tumor to originate from the meibomian glands. The tumor recurred rapidly to attain the size of 10×8×3 mm 2 weeks after excision. It was treated by wide excision by 25×13 mm of the lower eyelid under frozen section control. The defective eyelid was reconstructed with a tarso-conjunctival flap after Hughes method. The outer cutaneomuscular layer was repaired with full-thickness retroauricular skin graft. There has been no recurrence or metastasis during 11 months after surgery with gratifying functional and cosmetic results.