人造纤维性结膜肉芽肿的临床病理学特征研究

科研成果详情

题名	人造纤维性结膜肉芽肿的临床病理学特征研究
其他题名	The Observation of the Clinical and Histopathological Features of ConjunctivalSynthetic Fiber Granuloma
作者	尚茹茹
学位类型	硕士
导师	张宗端
答辩日期	2018-06-17
学位授予单位	温州医科大学
学位专业	眼科学
关键词	人造纤维异物肉芽肿结膜肿物
摘要	目的：总结并分析一组较大样本量的人造纤维性结膜肉芽肿患者的临床表现、组织病理学特征，加深对少见人造纤维性结膜肉芽肿的认识，有助于该病的诊断和治疗。资料与方法：收集温州医科大学附属眼视光医院2011年1月至2016年12月所收治的19例确诊为人造纤维性结膜肉芽肿患者的临床资料（包括发病年龄、性别、临床症状、眼部体征、异物的性质、部位等）和切除的离体组织标本，并对所有标本进行病理学检查，对部分标本进行免疫组织化学染色，最终总结人造纤维性结膜肉芽肿患者的临床病理学特征。结果：19例患者中男性患者6个（31.58%），女性患者13个（68.42%），男女比例约为1:2，年龄在3岁到17岁之间，平均年龄为7.1±4.0岁。19例患者病程最短1周，最长1年。（1）临床表现：患者均为单眼发病，右眼10例（52.63%），左眼9例（47.37%）。异物感16例（84.21%）、结膜局部充血11例（57.89%）、分泌物3例（15.79%），眼痛2例（10.53%）。结膜肉芽肿生长位置：结膜下方穹隆部13眼（68.42%）、下睑结膜3眼（15.79%）、上睑结膜2眼（10.53%）、结膜上方穹隆部1眼（5.26%）；形状：类圆形9例（47.37%）、长条状4例（21.05%）、不规则4例（21.05%）、菜花样1例（5.26%）及扁平状1例（5.26%）；大小：平均大小为（5.2±2.6）mm×（2.7±1.3）mm，最小为2mm×1mm，最大为10mm×5mm。（2）病理结果：病理诊断均为慢性异物肉芽肿性炎，见大量成纤维细胞和增生的新生血管，并伴有炎症细胞（主要为淋巴细胞、嗜酸性粒细胞）的浸润，外源性异物呈现圆形或椭圆形（14例，73.68%）、棱角状（4例，21.05%）、环状（1例，5.26%），颜色均匀，无中央核心，内部可含黑色颗粒，异物被多核巨细胞所包绕或吞噬。免疫组化染色结果：CD68（吞噬细胞+），PAS（杯状细胞+），六胺银（杯状细胞+），CK（结膜上皮+）。（3）治疗方法：18例（94.74%）患者经外科手术切除肿块，其中12例（63.16%）在局部麻醉下手术，6例（31.58%）在全身麻醉下手术。1例（5.26%）仅在裂隙灯下用眼科显微有齿镊取出。术后辅以糖皮质激素和抗生素局部治疗，患者症状消失且无复发。结论：人造纤维性结膜肉芽肿多发生于儿童，单眼发病为主，病灶以结膜下方穹隆部最常见。外科手术切除异物和肉芽肿是简单且最有效的治疗方式。病理学检查示人造纤维主要表现为均匀直径的圆形或椭圆形、无中央核心、内有微小的黑色颗粒，其被异物巨细胞环绕或吞噬，并伴随大量炎症细胞浸润。病理学检验和免疫组织化学染色检查可以将人造纤维性结膜肉芽肿与相似疾病鉴别。本研究以多样性人造纤维性结膜肉芽肿为例，通过对该病的临床病理学特征研究，以期加深对该病的认识，丰富临床资料库。
其他摘要	Purpose: Topresent the clinical and histopathologic features in a group of patientssuffered from conjunctival synthetic fiber granuloma. To deepen the knowledgeof rare conjunctival synthetic fiber granuloma, and to improve the accuracy of diagnosis.Methods: A retrospective analysis of 19 cases with conjunctival syntheticfiber granuloma from January 2011 to December 2016 in Eye Hospital of WenzhouMedical University. Their clinical data (including age, gender, clinical symptoms,signs, granuloma property, and position)were collected and the specimens were evaluated for histopathologic examinationand immunohistochemical staining. Results: In this study, there are 19 patients, 6 male patients (31.58%) and13 female patients (68.42%, male:femaleapproach to 1:2. The age range is from 3years old to 17 years old, the mean is 7.1±4.0 years old. All patients were unilateral, 10 cases in the righteye (52.63%), and 9 cases in the left eye (47.37%). The most common clinicalfeature in these patients is foreign body sensation in 16 eyes (84.21%), thenis a local conjunctival injection in 11eyes (57.89%), then is excretion in 3 eyes (15.79%), and pain in 2 eyes (10.53%).The location of the conjunctivalgranuloma is low fornix of 13 eyes (68.42%), low palpebral conjunctiva of 3eyes (15.79%), superior fornix of 1 eye (5.26%) and superior palpebralconjunctiva of 2 eyes (10.53%). The shapeof the conjunctival granuloma is oval in9 eyes (47.37%), strip-shaped in 4 eyes (21.05%), irregular in 4 eyes (21.05%)， cauliflower-like in 1 eye (5.26%) andflats in 1 eye (5.26%). The average size of conjunctival granuloma is（5.2±2.6）mm×（2.7±1.3）mm, ranges from2mm×1mm to 10mm×5mm. There is a foreignbody with sharp corners in 2 eyes (15.38%). The histopathological observationoutcome showed a chronic foreign bodygranulomatous inflammation with lots of fibroblasts and hyperplastic neovascularization,and around with a great many inflammatory cells infiltrated. The foreign body materialswere rounded or elliptic (14 cases, 73.68%), angular (4 cases, 21.05%), ring (1case, 5.26%), uniform color, no central core, and internal black particles,with surrounding by macrophagocytes. 12patients of 18 patients (94.74%) were treated by surgical excision under localanesthesia and 6 patients (31.58%) under general anesthesia. Only 1 patient (5.26%)was removed by microscope tweezers under the slit lamp. After the operation, allpatients were treated with glucocorticoid and antibiotic drops, and the symptomsdisappeared. All patients were clinicalcure without relapse.Conclusion: Conjunctival synthetic fiber granuloma commonly found in children, ismostly unilateral, and occurs in the lower eyelid. Synthetic fibers are usuallyfrom wool toys, blankets or pullovers made from synthetic fibers. Thehistopathological examination showed that the synthetic fibers were surroundedor swallowed by the foreign body giant cells, and infiltrated by a large numberof inflammatory cells. The foreign materials of synthetic fiber are fairlyuniform in diameter and usually round or oval. They lack a central core butsome small black granules. The histopathological observation and immunohistochemistryare helpful in identifying conjunctival synthetic fiber granuloma and othersimilar diseases. The most effective and simple treatment is surgical excision.
语种	中文
学号	1102020007
发布年限	2021-06-11
毕业论文分类号	R77
原始专题	眼视光学院、生物医学工程学院
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全文文件名	1102020007尚茹茹2018眼科学.pdf\|1102020007尚茹茹2018眼科学.pdf
文献类型	学位论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/111776
专题	温州医科大学
作者单位	溫州医科大学眼视光学院、生物医学工程学院
推荐引用方式 GB/T 7714	尚茹茹. 人造纤维性结膜肉芽肿的临床病理学特征研究[D]. 温州医科大学,2018.