脉络膜黑色素瘤敷贴放射治疗的初步观察  

Priliminary observation on choroidal melanoma treated by plaque radiotherapy

作　　者：王光璐[1] 魏文斌[1] 蔡善钰[2] 卢凤才[3] 马凯[1] 李斌[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 [2]中国原子能科学研究院 [3]中国科学院化学所

出　　处：《中华眼底病杂志》2006年第3期157-160,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察脉络膜黑色素瘤敷贴放射治疗的效果。方法采用国产敷贴器对间接检眼镜、荧光素眼底血管造影、吲哚青绿血管造影、B型超声等综合检查确诊的脉络膜黑色素瘤患者21例21只眼进行治疗。棕色实性隆起的圆形或椭圆形肿物位于黄斑周围者7只眼、视盘周围者7只眼、血管弓及附近者5只眼、周边部者2只眼。B型超声检查显示瘤体最大径为13．0mm×11．6mm×9．6mm。视力0．05及其以下者3只眼，0.06至0．2者4只眼，0．3及其以上者14只眼。敷贴器所用核素为^125I，设定照射总量为100～120Gy。其中肿瘤位于黄斑、视盘周围的14只眼同时合并采用经瞳孔温热疗法治疗。治疗后观察时间平均12个月，最长者达3年。以B型超声测量瘤体的基底及厚（高）度，若厚度超过原厚度的15％，或基底边缘大干原边缘250mm视为肿物增大。结果治疗后视力下降9只眼，不变10只眼，提高2只眼。瘤体增大6只眼，不变12只眼，缩小3只眼。并发玻璃体积血2只眼，视网膜血管阻塞1只眼，视网膜分支静脉阻塞1只眼，黄斑皱褶1只眼，视网膜出血3只眼，部分性视神经萎缩3只眼，新生血管性青光眼1只眼，眼球摘出3只眼。结论用国产敷贴器对脉络膜黑色素瘤进行放射治疗具有确切的疗效。但对瘤体较厚、肿瘤位于黄斑或视盘旁者效果较差。Objective To observe the therapeutic effect of plaque radiotherapy （PRT） on ehoroidal melanoma. Methods PRT was performed on 21 patients （21 eyes） with ehroidal melanoma who had been examined by ophthalmoscopy, fundus fluoreseein angiography （ FFA ）, indoeyanine green angiography （ICGA）, and B-scan eehography. The visual acuity was ≤0. 05 in 3 eyes, 0. 06-0. 2 in 4 eyes, and ≥0. 3 in 14 eyes before the treatment. Choroidal melanoma, round or oval brown solid hunch, was located at the area around maeula in 7 eyes, around the optic disc in 7 eyes. at or near the vascular arcade in 5 eases, and at the periphery in 2 eyes. The maximum length,width and thickness of tumor was 13 mm, 11.6 mm, and 9.59 mm. The isotope we used was ^125I, and the quantum of designed radiation was 100-120 Gy. Fourteen patients with ehoroidal melanoma at the macular area or around the optic disc underwent plaque radiotherapy associated with transpupillary thermotherapy （TTT）. The average followup duration was 12 months with the longest duration of 3 years. The basis and thickness （height） of tumors were measured by B-scan echography. The aggrandizement of the tumor would be regarded if the height increased 15% or the basis boundary aggrandized 250mm. Results The visual acuity after the treatment decreased in 9 eyes, remained unchanged in 10, and increased in 2. The dimension of tumo increased in 6 eyes, remained unchanged in 12, and decreased in 3. The complication was vitreous hemorrhage in 2 eys, vascular occlusion in 1, branch retinal venous occlusion in 1, maeular pucker in 1, retinal hemorrhage in 3, partial optic atrophy in 3, neovaseular glaucoma in 1, and extraction of eye in 3. Conclusion The domestic plaque design is effective on choroidal melanoma, and is of a sort on the thick tumor and the tumor located at maeula or beside the optic disc.

关 键 词：脉络膜肿瘤/放射疗法 黑色素瘤/放射疗法 碘^125 

分 类 号：R739.7[医药卫生—肿瘤] R815.2[医药卫生—临床医学]