原発性上皮型眼瞼部悪性腫瘍の切除後の再建術についての検討

Reconstruction of the eyelid after excision of primary epithelial malignant tumors

要約　目的：眼瞼部の上皮型悪性腫瘍を切除した後の眼瞼再建方法と合併症の検討。対象：2011年までの11年間に新潟大学附属病院眼科で手術を行った72例を対象とした。内訳は脂腺癌37例，基底細胞癌31例，扁平上皮癌3例，悪性黒色腫1例で，平均年齢は73歳である。結果：眼瞼の前葉再建は局所皮弁が52例，単純縫着が15例で行われた。後葉再建が行われた64例はすべて全層欠損で，前葉再建と同時に行われ，遊離瞼板移植が38例，単純縫着が15例，硬口蓋粘膜移植が11例に用いられた。上眼瞼全層の横幅70％以上が欠損した症例では，術後合併症のため3例で再手術が行われた。結論：従来の当科の方針で，ほとんどの例では再手術なしに眼瞼の再建ができた。上眼瞼全層幅の欠損が70％以上の例で課題が残った。

Abstract.　Purpose：To report the outcome and complications after excision of primary malignant tumors of the eyelid. Cases：This retrospective study was made on 72 cases who were treated by us during 11 years through 2011. The series comprised adenocarcinoma 37 cases, basal cell carcinoma 31 cases, squamous cell carcinoma 3 cases, and malignant melanoma one case. The age averaged 73 years. Results：Anterior layer of eyelid was reconstructed by local flap method in 52 cases and by simple suturing in 15 cases. Posterior layer was reconstructed in 64 cases by free tarsal graft transplantation in 38 cases, simple suturing in 15 cases, and transplantation of mucous membrane of hard palate in 11 cases. Additional surgery was needed in 3 cases with full-thickness defect involving 70％ of the width of upper eyelid. Conclusion：Our current strategy proved good for reconstruction of the eyelid except a few cases of large full-thickness defect of the upper eyelid.