大光斑间接眼底镜激光单独或联合全身化学药物治疗视网膜母细胞瘤  

The efficacy of large spot indirect ophthalmoscopy laser alone or combined with systemic chemotherapy in retinoblastoma therapy

作　　者：梁建宏[1] 程湧[1] 邓洵[1] 余盈盈[1] 黎晓新[1] 

机构地区：[1]北京大学人民医院眼科中心 视觉损失与修复教育部重点实验室 视网膜脉络膜诊治研究北京市重点实验室,100044

出　　处：《中华眼科杂志》2016年第10期745-748,共4页Chinese Journal of Ophthalmology

摘　　要：目的 观察大光斑间接眼底镜激光单独或联合全身化学药物治疗早、中期视网膜母细胞瘤（RB）的疗效.方法 回顾性系列病例研究.收集2009年3月至2014年8月北京大学人民医院眼科确诊的21例（22只眼）RB患儿的临床资料.患儿均详细记录病史及家族史,进行眼部超声、眼眶及头颅MRI或CT检查,眼部检查和激光治疗在全身麻醉下进行,每3～4周治疗1次,直至肿瘤得到控制.末次治疗后观察期至少3个月.每次眼部检查均进行眼压、眼前节及眼底检查,并用Retcam行眼底照像.所用激光治疗仪为810 nm波长的大光斑间接眼底镜激光.结果 21例患儿中男性16例,女性5例;就诊时年龄3～82个月,平均年龄17.3个月.22只眼中,4只为小肿瘤眼,8只为中等大肿瘤眼,10只为大肿瘤眼,2只眼单独激光治疗,20只眼激光联合全身化疗治疗.在平均33.9个月观察期中,15只肿瘤眼治疗成功,7只肿瘤眼治疗失败,总成功率为68.2％.小、中、大肿瘤眼治疗成功眼数和成功率分别为4只眼（100.0％）、5只眼（62.5％）和5只眼（50.0％）.有1例出现肿瘤脑转移死亡,该患儿对侧眼为E期.并发症：1只眼出现虹膜灼伤;1只眼出现较明显的玻璃体增殖;2只眼出现轻度玻璃体出血但未影响激光治疗,2只眼出现明显肿瘤出血并影响激光治疗;未出现并发白内障、医源性视网膜裂孔和激光爆破效应所引起的肿瘤玻璃体腔种植.结论 810 nm大光斑间接眼底镜激光单独或联合全身化疗,可有效治疗不晚于国际分期C期的早、中期肿瘤,适合治疗较大以及多发的视网膜母细胞瘤.Objective To evaluate the efficacy of large spot indirect ophthalmoscopy laser alone or combined with systemic chemotherapy in the treatment of early and middle stage retinoblastoma.Methods Retrospective series case study.Clinical data of 21 patients （22 eyes） who were diagnosed as retinoblastoma （RB） in Peking University People＆#39;s Hospital from March 2009 to August 2014 were collected.Medical and family history,ocular ultrasound,orbital and cranial MRI or CT examination of RB Children were detailed recorded.Ocular examination and laser treatment were performed under general anesthesia,once every 3-4 weeks until the tumor was under control.The observation period was at least 3 months after the last treatment.The ocular examination included intraocular pressure measurement,anterior segment and fundus examination and the fundus photography with Retcam.Laser therapeutic instrument was large spot indirect ophthalmoscopy laser of 810nm wavelength.Results Of the 21 children,16 were male and 5 were female.The range of age was 3 to 82 months averaged 17.3 months.Among 22 eyes,four with small tumor,eight with medium tumor,and ten with large tumor.Two eyes underwent laser treatment only and 20 eyes underwent laser treatment combined with systemic chemotherapy.During the average observation period of 33.9 months,15 tumors were treated successfully,but 7 failed.The total success rate was 68.2%.The number and success rate of small,medium and large tumor eyes were 4 （100%）,5 （62.5%） and 5 （50%）,respectively.There was one case of tumor brain metastases,and the classification of contralateral eye of the child was E phase.Complications：Iris burns happened in one eye,obvious vitreous proliferation in one eye and mild vitreous hemorrhage occurred in two eyes,which did not affect the treatment of laser.However,obvious tumor hemorrhage happened in two eyes and affected laser therapy.There was no complicated cataract,iatrogenic retinal hole and tumor intravitreal implant caused by laser blasting effect.Concl

关 键 词：视网膜母细胞瘤 检眼镜 激光疗法 药物疗法 肿瘤治疗方案 

分 类 号：R739.7[医药卫生—肿瘤]