当科における過去11年間の眼瞼脂腺癌症例の検討

An Eleven-Year Review of Eyelid Sebaceous Carcinoma Cases at Our Department

はじめに

　脂腺癌は，一般に眼瞼の皮脂腺であるマイボーン腺やツァイス腺から発生する悪性腫瘍である。眼瞼悪性腫瘍の30～40 ％を占めているとされており 1）2），特に最近の報告では脂腺癌が扁平上皮癌より増加傾向にある 3）4）。脂腺癌は基底細胞癌や扁平上皮癌と比べて，局所再発やリンパ節転移および遠隔転移が多く，悪性度も高いといわれている 1）5）。このため，十分なマージンをとって確実に腫瘍を切除することが重要である。一方で，眼球を保護するという眼瞼の重要な機能を維持し，かつ整容性を大きく損なわない眼瞼再建への配慮が必要である。

　今回われわれは，当科における過去11年間の脂腺癌の症例を後ろ向きに検討した。この検討により，眼瞼脂腺癌の臨床像を明らかにするとともに，切除マージンと再建方法，再建後の合併症，および予後について検討を行ったので報告する。

　The incidence of sebaceous carcinoma, which accounts for approx. 30 ％-40 ％ of malignant eyelid tumors, has increased in recent years. When indicated as treatment, a radical resection of sebaceous carcinoma with a sufficient resection margin is important. However, consideration must be given to preserve the protective function of the eyelid, and eyelid reconstruction that maximizes the cosmetic results is required. We reviewed the 18 cases of sebaceous carcinoma of the eyelid treated in our department over the past 11 years. The epidemiological characteristics and clinical features of the tumors were consistent with previous reports in Asian populations. The average excision margin was 7 mm for the upper eyelid and 5 mm for the lower eyelid. Two cases had lesions on both upper and lower eyelids: one of these cases had a 5 mm excision margin that included the lateral canthus, and the other had a 15 mm margin and involved orbital exenteration. In all 18 cases, eyelid reconstruction was required after the tumor’s resection. More than half of the affected upper eyelids were reconstructed with a switch flap from the lower eyelid, whereas the lower eyelid was usually reconstructed using a cheek rotation flap for the anterior lamella and a palatal mucosal transplant or a nasal septal cartilage with nasal mucosa transplant for the posterior lamella. Two cases had recurrence during the postoperative follow-up period, and both cases had lesions extending to the upper and lower eyelids. In eyelid reconstruction after tumor resection, postoperative swelling and changes in the transplanted tissue should be considered. In addition, a less-invasive method with a lower complication rate is needed.