CAJ | 학술논문

目的观察巩膜表面敷贴放射(PRT)联合经瞳孔温热疗法(TTT)治疗脉络膜黑色素瘤(CM)的治疗效果.方法采用国产巩膜敷贴器联合TTT对30例CM患者的30只眼进行治疗.其中,男性15例,女性15例;均为单眼.视力0.1～0.8,平均视力0.3±0.2.肿瘤最大基底径6.80～17.90 mm,平均最大基底径(11.30±2.80)mm;高度3.90～10.60 mm,平均高度(7.20±2.40)mm.肿瘤局部控制标准:对比B型超声测量下的肿瘤大小,若肿瘤高度增加2.00 mm或肿瘤任意一边界扩展0.25 mm视为肿瘤生长.治疗后随访15～57个月,平均随访时间(33.01±9.81)个月,观察肿瘤局部控制率、眼球保存率、治疗后视力以及治疗后并发症的发生情况.结果治疗后肿瘤最大基底径4.60～17.00 mm,平均最大基底径为(9.79±3.35)mm.与治疗前肿瘤平均最基底径比较,差异有统计学意义(t=2.195,F=0.49;P=0.032);肿瘤高度为2.70～11.90 mm,平均高度(5.19±2.57)mm.与治疗前肿瘤平均高度比较,差异有统计学意义(t=2.069,F=0.018;P=0.043).末次随访时,肿瘤最大基底径较治疗前最大基底径增加2只眼;肿瘤高度较治疗前肿瘤高度增加2只眼.肿瘤局部控制率为86.7%.治疗后眼球摘除3只眼,眼球保存率为90.0%.视力保持稳定12只眼,占40.0%;视力提高1只眼,占3.3%;视力下降17只眼,占56.7%.出现放射性视网膜病变12只眼,占40.0%;继发性视网膜脱离3只眼,占10.0%,其中伴有继发性青光眼1只眼;白内障4只眼,占13.3%;干眼症症状5只眼,占16.7%.结论 PRT联合TTT能有效控制肿瘤生长,并发症发生率低.
목적 관찰공막표면부첩방사(PRT)연합경동공온열요법(TTT)치료맥락막흑색소류(CM)적치료효과.방법 채용국산공막부첩기연합TTT대30례CM환자적30지안진행치료.기중,남성15례,녀성15례;균위단안.시력0.1～0.8,평균시력0.3±0.2.종류최대기저경6.80～17.90 mm,평균최대기저경(11.30±2.80)mm;고도3.90～10.60 mm,평균고도(7.20±2.40)mm.종류국부공제표준:대비B형초성측량하적종류대소,약종류고도증가2.00 mm혹종류임의일변계확전0.25 mm시위종류생장.치료후수방15～57개월,평균수방시간(33.01±9.81)개월,관찰종류국부공제솔、안구보존솔、치료후시력이급치료후병발증적발생정황.결과 치료후종류최대기저경4.60～17.00 mm,평균최대기저경위(9.79±3.35)mm.여치료전종류평균최기저경비교,차이유통계학의의(t=2.195,F=0.49;P=0.032);종류고도위2.70～11.90 mm,평균고도(5.19±2.57)mm.여치료전종류평균고도비교,차이유통계학의의(t=2.069,F=0.018;P=0.043).말차수방시,종류최대기저경교치료전최대기저경증가2지안;종류고도교치료전종류고도증가2지안.종류국부공제솔위86.7%.치료후안구적제3지안,안구보존솔위90.0%.시력보지은정12지안,점40.0%;시력제고1지안,점3.3%;시력하강17지안,점56.7%.출현방사성시망막병변12지안,점40.0%;계발성시망막탈리3지안,점10.0%,기중반유계발성청광안1지안;백내장4지안,점13.3%;간안증증상5지안,점16.7%.결론 PRT연합TTT능유효공제종류생장,병발증발생솔저.
Objective To observe the therapeutic efficacy and complications of plaque radiotherapy (PRT) combined with transpupillary thermotherapy (TTT) on choroidal melanoma (CM). Methods Thirty unilateral CM patients (30 eyes, including 15 males and 15 females) were treated by PRT and TTT.The visual acuity ranged from 0. 1 to 0. 8 with an average of 0. 3 ± 0.2. The largest base diameter of tumor ranged from 6. 8 mm to 17. 9 mm with an average of (11.3±2.8) mm;The tumor height ranged from 3.9mm to 10.6 mm with an average of (7.2±2.4) mm. The criteria of controlled local tumor: based on B-scan ultrasound measurement, the tumor was considered as "growing" if tumor height increased 2 mm or tumor largest base diameter increased 250 μm, otherwise the tumor was considered "controlled". The follow-up ranged from 15 to 57 months with an average (33.01 ± 9. 81) months. The local tumor control rate,enucleation rate and visual acuity, complications after treatment were observed. Results The tumor largest base diameter after treatment ranged from 4.6 mm to 17.0 mm with an average (9.79±3.35) mm, which had statistically significant difference(t=2. 195,F=0.49;P=0. 032) with that before treatment. The tumor height after treatment ranged from 2.7 mm to 11.9 mm with an average (5.19±2.57) mm, which had statistically significant difference(t = 2. 069, F= 0. 018;P = 0. 0435 ) with that before treatment. At the end of follow up, the tumor largest diameter and height increased in two eyes respectively compared with those before treatment. Local tumor control rate was 86.7 %. Three eyeballs were enucleated after treatment, the enucleation rate was 10. 0%. The visual acuity remained unchanged in 12 eyes, improved in one eye and decreased in 17 eyes. Treatment complications included radiation retinopathy in 12 eyes (40.0%),secondary retinal detachment in three eyes (10. 0 % ), secondary glaucoma in one eye (3.3 % ), cataract in four eyes (13.3%) and dry eye syndrome in five eyes (16.7%). Conclusion PRT combined with TTT is an effective therapy for choroidal melanoma with less complications.