CAJ | 학술논문

目的探讨超选眼动脉介入灌注美法仑治疗眼内期视网膜母细胞瘤(RB)技术要点及评价该项治疗的安全性、有效性.方法 2009年4月至2012年6月在武警总医院RB治疗中心诊断为眼内期RB,并行超选眼动脉介入灌注美法仑治疗的患儿53例,患眼65只.其中,男38例,女25例,年龄范围4～48个月,平均20.1个月.采用介入技术将微导管放置到位,缓慢泵入美法仑,单眼总时间大于30 min.两次介入化疗间隔1个月.观察患儿术中、术后外眼及全身临床表现变化及治疗前后血常规、肝肾功能变化.检测肿瘤化疗后缩小程度.随诊时间2～41个月.结果 53例患儿中14例18眼行1次化疗,35例43眼行2次化疗,4例4眼行3次化疗,累计行超选眼动脉介入灌注美法仑治疗116例次.无严重的全身系统及手术操作并发症发生,部分病例出现眼部局部并发症,包括眶周皮肤水肿、眼睑下垂、眼球活动障碍、玻璃体出血等,均在随访期内缓解,末遗留严重功能障碍.53例患儿65只患眼中,55只眼肿瘤不同程度缩小,有效率84.6％,10只眼因肿瘤进展而行眼球摘除(15.4％).结论本组结果显示超选眼动脉介入灌注美法仑治疗眼内期RB是一种安全有效地临床技术,远期效果需进一步增加病例及随诊时间进行观察研究.
목적 탐토초선안동맥개입관주미법륜치료안내기시망막모세포류(RB)기술요점급평개해항치료적안전성、유효성.방법 2009년4월지2012년6월재무경총의원RB치료중심진단위안내기RB,병행초선안동맥개입관주미법륜치료적환인53례,환안65지.기중,남38례,녀25례,년령범위4～48개월,평균20.1개월.채용개입기술장미도관방치도위,완만빙입미법륜,단안총시간대우30 min.량차개입화료간격1개월.관찰환인술중、술후외안급전신림상표현변화급치료전후혈상규、간신공능변화.검측종류화료후축소정도.수진시간2～41개월.결과 53례환인중14례18안행1차화료,35례43안행2차화료,4례4안행3차화료,루계행초선안동맥개입관주미법륜치료116례차.무엄중적전신계통급수술조작병발증발생,부분병례출현안부국부병발증,포괄광주피부수종、안검하수、안구활동장애、파리체출혈등,균재수방기내완해,말유류엄중공능장애.53례환인65지환안중,55지안종류불동정도축소,유효솔84.6％,10지안인종류진전이행안구적제(15.4％).결론 본조결과현시초선안동맥개입관주미법륜치료안내기RB시일충안전유효지림상기술,원기효과수진일보증가병례급수진시간진행관찰연구.
Objective To assess the safety and effectiveness of superselective ophthalmic intraarterial melphalan therapy for children with advanced intraocular retinoblastoma (RB).Methods In the RB Treatment Center of General Hospital of Armed Police Forces between April 2009 and June 2012,65 eyes of 53 patients who were diagnosed intraocular RB treated with superselective ophthalmic intra-arterial melphalan therapy.Among them,38 patients were male and 25 patients were femal with age range from 4 to 48 months,average 20.1 monthes.The microcatheter was posited in opening of treated side ophthalmic artery with intervention technics.Melphalan then delivered in 30 minutes per ill eye.Each month had once treatment.The ophthalmic and the whole body evaluations were performed during treatment phase and after treatment for each circle.Follow-up range was 2 to 41 months.Results 18 eyes of 14 patients were treated 1 circle,43 eyes of 35 patients were treated 2 circles and 4 eyes of 3 patients were treated 3 circles (tatal 116 times).Successful superselective ophthalmic intra-arterial melphalan therapies were achieved in all cases,and no severe side effects occurred during treatment.In 65 eyes of 53 patients,55 eyes(84.6％) were in remission.10 eyes were performed enucleation as tumors advanced.Conclusions Superselective ophthalmic intra-arterial melphalan therapy is a safe and effective method in treating advanced intraocular retinoblastoma,but further follow-up is required to confirm treatment long-term effectiveness.