影响葡萄膜黑色素瘤局部切除手术治疗预后的多因素分析  

Analysis of multiple factors affecting the prognosis of local excision for uveal melanoma

作　　者：魏文斌[1] 田蓓[1] 王凤华[1] 傅涛[1] 杨文利[1] 李彬[1] 胡士敏[1] 

机构地区：[1]首都医科大学附属北京同仁医院眼科中心,100730

出　　处：《中华眼底病杂志》2006年第3期154-156,共3页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察葡萄膜黑色素瘤局部切除手术的疗效和安全性，探讨其影响预后的因素。方法回顾分析45例经组织病理学检查证实为葡萄膜黑色素瘤的患者行局部切除手术治疗的临床资料。分析患者年龄、性别、肿瘤最大直径、肿瘤部位、有无视网膜脱离、手术前后眼压、视力等基线资料以及手术方法、是否联合治疗等干预手段与生存预后的相互关系。将各因素作为协变量与肿瘤转移复发预后建立COX回归模型。结果各因素中，肿瘤最大直径和高度（P=0．04）、手术后眼压（P=0．03）、病理分型（P=0.04）、巩膜有无浸润（P=0．03）、肿瘤部位（P=0．01）、切除完整与否（P=0．00）与转移和复发有显著相关意义。20-40个月为肿瘤复发转移高发期。结论葡萄膜黑色素瘤局部切除手术是治疗该病的有效方法之一。手术后20-40个月时应密切随诊观察，必要时联合其他治疗。Objective To observe the therapeutic effects and security of the local resection for uveal melanoma, and to detect the factors which affect the prognosis. Methods The clinical data of 45 patients with uveal melanoma who had undergone local resection after examined by histopathology were retrospectively analyzed, including the age, sex, the longest diameter, the location of the tumor, with or without retinal detachment, intraocular pressure （IOP） and visual acuities before and after the operation, and the visual acuity. The relationship between the therapeutic method and the survival prognosis was analyzed. COX regression model was set up with knubbly metastasis relapse prognosis and the multiple factors which was the assistive variables. Results Among these factors, the metastasis and relapse had obvious relation to the longest diameter and height of the tumor （P= 0. 04）, the IOP after operation （P= 0.03）, pathologic classification （P=0. 04）,with or without scleral infiltration （P=0. 03）,the location of the tumor （P=0. 01） and complete or incomplete resection （P=0. 00）. The period when the metastasis and relapse of tumor were most likely to happen was 20 to 40 months. Conclusion Local resection is one of the effective methods for uveal melanoma. These patients should be followed up closely from 20 to 40 months after operation, and if necessary, should be treated combined with other treatments.

关 键 词：葡萄膜肿瘤/外科手术 黑色素瘤/外科手术 

分 类 号：R739.7[医药卫生—肿瘤] R779.6[医药卫生—临床医学]