超选眼动脉介入灌注美法仑联合卡铂治疗晚期视网膜母细胞瘤  

Super selected ophthalmic artery interventional perfusion melphalan combined with carboplatin for later retinoblastoma

作　　者：刘扬帆[1] 万里新[1] 

机构地区：[1]南阳市中心医院肿瘤内科,河南省南阳市473009

出　　处：《眼科新进展》2016年第4期362-364,共3页Recent Advances in Ophthalmology

摘　　要：目的探讨超选眼动脉介入灌注美法仑联合卡铂治疗眼内晚期视网膜母细胞瘤的临床效果,以期改善患儿预后。方法选取经全身化疗失败的眼内晚期视网膜母细胞瘤患儿49例（67眼）,行眼动脉灌注化疗,化疗采用卡铂联合美法仑方案,每4周1次,每次化疗结束后对患儿的一般情况及不良反应进行观察,每次治疗后4周通过超声检查和眼底检查对瘤体大小和消退情况进行评价。结果所有患儿均股动脉穿刺插管和眼动脉插管治疗成功。患儿在进行介入治疗后,67眼中20眼瘤体完全消失,在局部形成钙化灶或者瘢痕,无复发及转移;27眼瘤体缩小;其余20眼中10眼肿瘤复发,2例（3眼）为术后3个月复查时发现肿瘤复发,放弃治疗死亡;2例（2眼）于术后6个月发现肿瘤侵犯视神经并伴颅内转移死亡;其余5眼肿瘤复发,5眼玻璃体内广泛种植,3眼视网膜下种植,2眼玻璃体出血,均行眼球摘除。治疗后瘤体最大径以及厚度均较治疗前明显缩小,与治疗前相比差异有统计学意义（P〈0.05）,其中最大径≤3 mm的瘤体在治疗1~2次后仅能看到钙化灶以及瘢痕;最大径〉3 mm的瘤体经过多次治疗也发生不同程度缩小。部分患儿在术后出现了一过性的眼周和全身不适,但未造成严重不良后果。结论超选眼动脉介入灌注美法仑联合卡铂治疗眼内晚期视网膜母细胞瘤可以取得一定的效果,且治疗较为安全。临床医师应不断提高介入技术,为患儿提供更好的服务。Objective To discuss the clinical effects of optional artery interventional perfusion melphalan combined with carboplatin for later retinoblastoma in order to improve the prognosis of children. Methods Forty-nine cases（ 67 eyes） with later retinoblastoma after systemic chemotherapy failure were chosen,the ophthalmic artery perfusion chemotherapy was performed,chemotherapy was given with carboplatin combined with melphalan scheme,once for every 4 weeks,the patient＇s general condition and adverse reactions at every time after the chemotherapy were observed,and the ultrasound examination and fundus examination were performed at 4 weeks after treatment to evaluate the tumors size and fade. Results The puncture and intubation of femoral artery and ophthalmic artery in all children were successful. Children after intervention treatment,the tumors in 20 eyes completely disappeared,the local calcifications or scar were formed with no recurrence and metastasis; The tumors in 27 eyes narrowed; In remaining 20 eyes,10 eyes recurred,2 cases（ 3 eyes） recurred at postoperative 3 months and given up the treatment to death; In 2 cases（ 2 eyes）,the optic nerve and tumor was invaded with intracranial metastases,and died at postoperative 6 months; The tumor in rest 5 eyes recurred,5 eyes vitreous widely cultivated,3 eyes cultivated under reti-na,vitreous hemorrhage appeared in 2 eyes,all eyeball were removed. The maximum diameter and thickness of tumors was significantly reduced,the difference was statistically significant compared with pre-operation（ P 0. 05）,the tumors with the maximum diameter of 3 mm or less only could find the calcifications and scar after treatment for once or two times; The tumors with the maximum diameter 3 mm had different degrees of shrink after treatment for more times. Some children had transient discomfort of eye or body after surgery,but did not have serious adverse consequences. Conclusion The selected ophthalmic artery interventional perfusion melphalan combined with carboplatin fo

关 键 词：视网膜母细胞瘤 眼动脉 介入治疗 

分 类 号：R739.7[医药卫生—肿瘤]