CAJ | 학술논문

目的分析眼眶视网膜母细胞瘤(RB)患儿行眶内容物摘除术的原因.方法回顾性系列病例研究.分析1999年11月至2010年11月间在武警总医院眼眶病研究所因眼眶RB行眶内容物摘除术的17例患儿资料.记录患儿的眼部病史及诊疗过程、眼部临床表现、手术术式、术后病理诊断及随访结果.根据患儿的病史及诊疗经过分析眼部病情进展及最终行眶内容物摘除术的原因.结果 17例患儿的平均年龄3.2岁,男女性别比率1.1∶1,患儿常见的临床表现为眶区肿物11例,其次为眼球突出7例,眼睑红肿3例,结膜充血水肿和(或)结膜下隆起4例,眼眶疼痛2例.单眼发病患儿11例,双眼发病者6例.分析患儿行眶内容物摘除术的原因:患儿父母因顾虑治疗费用、预后不佳等原因放弃先期治疗机会,导致病情进展不得不行眶内容摘除术7例;眼内RB行眼球摘除术后发生眶内复发5例;眼内RB单纯保守治疗(静脉化疗或局部放疗)无法控制病情而进展为眼眶RB 3例;由误诊行前房穿刺、前房灌洗、玻璃体切除术等操作导致肿瘤快速眶内蔓延2例.结论家属放弃治疗、眼球摘除术后发生眶内复发、单纯保守治疗导致病情延误、误诊误操作导致病情快速进展是眼眶RB患儿行眶内容物摘除术的主要原因.
목적 분석안광시망막모세포류(RB)환인행광내용물적제술적원인.방법 회고성계렬병례연구.분석1999년11월지2010년11월간재무경총의원안광병연구소인안광RB행광내용물적제술적17례환인자료.기록환인적안부병사급진료과정、안부림상표현、수술술식、술후병리진단급수방결과.근거환인적병사급진료경과분석안부병정진전급최종행광내용물적제술적원인.결과 17례환인적평균년령3.2세,남녀성별비솔1.1∶1,환인상견적림상표현위광구종물11례,기차위안구돌출7례,안검홍종3례,결막충혈수종화(혹)결막하륭기4례,안광동통2례.단안발병환인11례,쌍안발병자6례.분석환인행광내용물적제술적원인:환인부모인고필치료비용、예후불가등원인방기선기치료궤회,도치병정진전불득불행광내용적제술7례;안내RB행안구적제술후발생광내복발5례;안내RB단순보수치료(정맥화료혹국부방료)무법공제병정이진전위안광RB 3례;유오진행전방천자、전방관세、파리체절제술등조작도치종류쾌속광내만연2례.결론 가속방기치료、안구적제술후발생광내복발、단순보수치료도치병정연오、오진오조작도치병정쾌속진전시안광RB환인행광내용물적제술적주요원인.
Objective To analyze the reasons of orbital exenteration for orbital retinoblastoma (RB) patients.Methods Retrospective case series study.Clinical records were reviewed retrospectively of 17 orbital RB patients who had undergone exenteration from November 1999 to November 2010 at Armed Police General Hospital.The clinical records included ophthalmic history,process of diagnosis and treatment,symptom and signs,surgical approach,pathological diagnosis and follow-up results.The reasons of orbital exenteration for orbital RB patients according to medical history,process of diagnosis and treatment were analyzed.Results The average age of patient was 3.2 years old.The ratio of male versusfemale was 1.1 ∶ 1.The common clinical findinds were as following:11 cases of orbital mass,7 cases of exophthalmos,6 cases with palpebral edema,4 cases of conjunctival congestion and edema with conjunctival mass,and 2 cases with orbital pain.Reasons for orbital exenteration were as following:7 patients who lost the opportunity of the treatment because of concernning about the cost of treatment and poor prognosis and caused worst outcome.Exenteration had to be done eventually.Five cases of orbital recurrence happened after enucleation.Three patients' Rb invaded into orbit after conservative treatmentintravenous chemotherapy or radio therapy alone.Two cases were misdiagnosed and mishandled causing rapidly tumor spread into the orbit.Conclusions The major reasons of orbital exenteration for orbital RB patients lies in the following:giving up treatment from patients,tumor recurrence in the orbit after enucleation,progressing of orbital RB after simple conservative treatment,misdiagnosis and mishandling to let RB invade into orbit rapidly.