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1. 病人仰卧,常规消毒铺巾。

2. 右眼外眦保留,外侧皮肤水平切口(约2cm),分离皮下组织到眶缘骨膜,电刀切开骨膜,剪开眶外侧壁骨膜,见球后充满肿瘤组织,色紫红,表面为薄壁包膜,包膜表面密布血管,其内为暗红色液体,符合脉管瘤伴出血、血肿表现。

3. 钝性分离肿瘤包膜与周围组织粘连,穿刺包膜,抽出8ml积血,注入Glubran2胶与碘化油混合液(1:2)0.5ml。仔细探查球后眶深部脉管瘤组织已基本被有效栓塞变硬,因肿瘤与眶尖部神经、血管等重要组织粘连,包饶,切除后将造成大量出血切无法止血,易造成术后视力丧失等并发症,不予切除。

4. 栓塞后框压升高,考虑畸形血管团内有新鲜出血,剪开球后畸形血管团包膜,用出鲜血,框压缓解,填塞止血海绵、缝扎血管并压迫止血。

5. 为缓解眼球突出及避免术后高框压,讲筛骨纸板和内下隅角骨质部分切除贸易扩大眶腔。


Name of Procedure: right orbital hematoma resection via combined medial and lateral orbitotomy + embolization for vascular tumor + decompression of orbital medial wall

Anesthesia Method: general anesthesia

Procedure Description:

1.     The patient was in supine position, prepped and draped in the usual sterile manner.

2.     The outer canthus of right eye was preserved. A horizontal incision in lateral skin was made (about 2cm in length). The subcutaneous tissue was separated, to the periosteum of orbital border. The periosteum was cut open with electrotome. The periosteum of lateral wall was cut open. The retrobulbar region was full of tumor tissue, purple in color, with superficial thin-walled capsule which was covered with blood vessels, with internal dark-red fluid, consistent with vascular tumor with hemorrhage and hematoma.

3.     Via blunt dissection, the tumor capsule was separated from adhesion with surrounding tissue. The capsule was punctured and 8ml hematocele was drained. 0.5ml mixture of Glubran 2 seal and Lipiodol was injected (1: 2). Exploration indicated that the vascular tumor tissue in retro-bulbar deep orbit grossly hardened after effective embolization. Since the tumor was adhered to and encircled by the nerve and vessel in orbit apex, resection would cause massive hemorrhage and hemostasis couldn't be achieved so it would cause vision loss and other complications. Therefore, resection was not be performed.

4.     After embolization, the orbital pressure increased, suggestive of new hemorrhage in the malformed vascular mass. The capsule of retro-bulbar malformed vascular mass was cut open, the fresh blood poured out and the orbital pressure was relieved. Tamponade was given using hemostatic sponge, the vessel was sutured and compression hemostasis was achieved.

5.     To relieve exophthalmos and avoid postoperative high orbital pressure, partial bone of ethmoid lamina papyracea and inner lower corner region was resected to enlarge the orbital cavity.

6.     There was no active hemorrhage or blood oozing. The exophthalmos was improved markedly. A drainage tube was placed in surgical region. The bone flaps were repositioned and the incision was closed layer by layer. The operation processed smoothly.