化学减容术联合局部疗法治疗眼内晚期视网膜母细胞瘤的近期疗效观察  

Short-term therapeutic effect of chemoreduction treatment combined with focal therapy for advanced intraocular retinoblastoma

作　　者：孙红[1] 高飞[2] 李颖[3] 王利华[1] 孔冬[1] 张丽娟[3] 郭威[1] 丛培芹[1] 王荣[1] 刘真[1] 

机构地区：[1]山东省立医院眼科,济南250021 [2]山东省立医院儿科,济南250021 [3]山东省立医院西院儿科

出　　处：《中华眼底病杂志》2007年第5期336-339,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：山东省人事厅留学回国人员科技活动择优资助项目（鲁人办发[2006]118号）

摘　　要：目的观察化学减容术联合眼肿瘤局部加强治疗方法治疗晚期眼内视网膜母细胞瘤的疗效。方法对9例13只视网膜母细胞瘤（RB）患眼采用化学减容术联合眼肿瘤局部冷冻和（或）经瞳孔温热疗法（TTT）进行治疗,并对其临床随访资料进行回顾性分析。化学减容术采用长春新碱,卡铂和依托箔苷（VEC）方案。平均随访时间15.3个月。结果所有13只患眼均对化学减容术显示出良好初始反应。经第一疗程化疗后,肿瘤基底最大直径平均缩小37.2%;肿瘤厚度平均缩小46.7%。6只眼视网膜下积液部分或完全吸收,10只眼视网膜下肿瘤种植明显减少、消失或钙化,11只眼玻璃体内肿瘤种植明显减少、消失或钙化。治疗期间及治疗后随访期间共有8只眼出现了肿瘤和（或）肿瘤种植的复发和（或）新发,经补充冷冻和（或）TTT治疗后,最终2只眼（2/13）摘除,11只眼得以保留,其中8只眼恢复或保持较好有用视力。9例患者均未发生白血病、肝肾功能及听力损害等严重化学治疗毒性反应。结论对高度进展的晚期RB,化学减容术在治疗初期显示了良好的初始反应。化学减容术联合眼肿瘤局部加强疗法近期内可有效控制视网膜肿瘤、视网膜下种植及玻璃体内种植;远期疗效有待继续观察。Objective To observe the therapeutic effect of chemoreduction treatment combined with local focal therapy for advanced intraocular retinoblastoma （RB）. Methods Thirteen eyes of nine patients with RB underwent chemoreduction treatment combined with local cryotherapy and （or） transpupillary thermotherapy （TTT）, and the clinical data of the patients were retrospectively analyzed. The vincristine, etoposide, and carboplatin （VEC） were used in the chemoreduction treatment. The average follow-up duration was 15.3 months. Results All of the 13 eyes with RB had favorable initial reaction in the treatment of chemoreduction. After the first period of chemotherapy, the largest diameter of the tumor fundus decreased 37.2%, and the tumor thickness averagely reduced 46.7 %. The subretinal fluid was absorbed completely or partially in 6 eyes （6/8）; vitreous and subretinal seeds reduced, disappeared or calcified in 10 （10/11） and 11 eyes （11/11）, respectively. During the treatment and in the follow-up duration, 8 eyes （8/13） had new tumors and （or） recurrences. Finally, 2 eyes （2/13） were enucleated while 11 eyes （11/13） were saved in which 8 （8/11） recovered or remained good visual acuity. None of 9 patients had serious side effects of chemotherapy like leucocythemia, functional damage of liver and kidney, and dysacousia. Conclusions Chemoreduction treatment has well initial effect on advanced RB. Chemoreduction treatment combined with local treatment may effectively control the retinal tumor, subretinal seeds and vitreous seeds within a short-term duration. The evaluation of long-term effect of the treatment needs further observation.

关 键 词：视网膜母细胞瘤/治疗 药物疗法 联合 激光凝固术 冷冻疗法 

分 类 号：R686[医药卫生—骨科学]