Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Malign Kapak Tümörlerinde Rekonstrüktif Cerrahi Seçimi ve İzlem Sonuçları
Choice of Reconstructive Surgery and Follow-Up Results in Malignant Eyelid Tumors
Gülsüm GENÇa, Nigar RÜSTAMLİa, A. Kaan GÜNDÜZa
aAnkara Üniversitesi Tıp Fakültesi Göz Hastalıkları ABD, Ankara, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2021;30(1):48-54
doi: 10.5336/ophthal.2020-78177
Article Language: TR
Full Text
ÖZET
 Amaç: Malign kapak tümörlerinde uygulanan rekonstrüktif cerrahi ve izlem sonuçlarını bildirmek. Gereç ve Yöntemler: 1999-2019 yılları arasında malign kapak tümörü tanısıyla tümör eksizyonu yapılan 135 olguda, kapak rekonstrüksiyonu için kullanılan cerrahi teknikler ve izlem sonuçları retrospektif olarak incelendi. Bulgular: Elli altı (%41,5) olguda alt kapak, 22 (%16,3) olguda iç kantus, 23 (%17,1) olguda üst kapak, 3 (%2,2) olguda dış kantus, 7 (%5,1) olguda birden fazla kapak bölgesi ve 24 (%17,8) olguda orbita tutulumu mevcut idi. Histopatolojik inceleme sonucunda, en sık bazal hücreli karsinom (98 olgu, %72,6) tanısı konmuştur. Rekonstrüksiyonda, alt kapak tümörlerinde en sık kullanılan ilk 2 yöntem Tenzel flebi (28 olgu, %20,8) ve Hughes tarsokonjonktival flep ve deri greftidir (10 olgu, %7,4). İç kantus tümörlerinde en sık deri grefti (11 olgu, %8,1) ve glabellar flep (4 olgu,%3,0) uygulanmıştır. Üst kapak tümörlerinde en sık Tenzel flebi (9 olgu, %6,7) ve primer kapama (6 olgu, %4,4) tercih edilmiştir. Dış kantus tümörlerinde deri grefti (2 olgu, %1,5) ve kaydırma flebi (1 olgu, %0,7) uygulanmıştır. Orbita yayılımı olan 24 olguya total ekzenterasyon yapılmıştır. Ortalama 68,2 ay izlemde 12 (%8,9) olguda nüks gelişmiş ve tedavi edilmiştir. Sonuç: Serimizde üst ve alt kapak malign tümörlerinde Tenzel flebi, iç ve dış kantüs tümörlerinde deri grefti en sık kullanılan rekonstrüktif yöntemler olmuştur. Orbita yayılımı gösteren olgularda ekzenterasyon uygulanmıştır.

Anahtar Kelimeler: Rekonstrüktif cerrahi prosedürleri; göz kapakları; göz kapağı tümörleri; karsinom; bazal hücreli karsinom; skuamöz hücre; radyoterapi
ABSTRACT
 Objective: To report the results of reconstructive surgery and follow up in patients with malignant eyelid tumors. Material and Methods: The surgical techniques used in eyelid reconstruction and follow up in 135 cases with malignant eyelid tumors treated between 1999 and 2019 were retrospectively reviewed. Results: The tumor affected the lower eyelid in 56 cases (41.5%), inner canthus in 22 cases (16.3%), upper eyelid in 23 cases (17.1%), outer canthus in 3 cases (2.2%), more than one eyelid region in 7 cases (5.1%), and orbit in 24 cases (17.8%). The most common histopathological diagnosis was basal cell carcinoma (98 cases, 72.6%). In reconstruction, the two most commonly used methods in lower eyelid tumors were Tenzel flap (28 cases, 20.8%) and Hughes tarsoconjunctival flap and skin graft (10 cases, 7.4%). In inner canthus tumors, skin graft (11 cases, 8.2%) and glabellar flap (4 cases, 3.0%) were the most commonly used methods. In upper eyelid tumors, Tenzel flap (9 cases, 6.7%) and primary closure (6 cases, 4.4%) were the most commonly used methods. In outer canthus tumors, skin graft (2 cases, 1.5%) and advancement flap (1 case, 0.7%) were used. Total exenteration was performed in 24 cases with orbital invasion. At a mean of 68.2 months follow-up, 12 patients (8.9%) developed recurrence and were retreated. Conclusion: In our series, Tenzel flap for upper and lower eyelid malignant tumors and skin graft for inner and outer canthus tumors were the most commonly used reconstruction methods. Exenteration was performed in cases showing orbital involvement.

Keywords: Reconstructive surgical procedures; eyelid neoplasms; carcinoma, basal cell carcinoma; squamous cell; radiotherapy
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