视网膜母细胞瘤患者全身化学药物治疗联合局部治疗的临床效果

摘要

目的：观察视网膜母细胞瘤（ retinoblastoma ，RB）患者全身化学药物治疗联合局部治疗的临床效果。方法临床纳入RB患者19例，共有28只眼接受了全身化学药物治疗联合局部治疗。全身化疗一般进行6个疗程，每个疗程3～4周，主要化疗药物包括长春新碱、环磷酰胺、依托泊甙以及卡铂等。此外，根据患者的情况给予局部治疗。局部治疗方法包括激光光凝、冷冻、经瞳孔温热疗法、钌106放射敖贴器局部放疗以及眼球摘除等。对患者进行3～61个月的随访，平均随访时间为31个月。观察患者的临床生存率、眼球保留率以及临床疗效。结果随访1年内，有16例患者存活，存活率为84．21％，转移率为5．26％；2年内生存率为78．95％，转移率为10．53％。对16例存活患者23只患眼进行分析，发现肿瘤分期为Ⅰ～Ⅱ期、Ⅲ～Ⅳ、Ⅴ期者眼球保留率分别为100．00％、40．00％、16．67％。3例死亡病例均为肿瘤分期Ⅳ期及以上的患者。结论 RB患者进行全身化学药物联合局部治疗，具有较好的临床疗效，早期治疗患者患眼的保留率较高。%Objective To study the clinical effects of systemic chemotherapy combined with local treatment for retino -blastoma.Methods 19 retinoblastoma patients were selected of which 28 eyes adopted systemic chemotherapy combined with lo-cal treatment.In general,the systemic chemotherapy took 6 courses,3~4 weeks was a course.The major chemotherapy drug in-cluded vincristine,cyclophosphamide,etoposide,carboplatin,etc.The patients also adopted local treatment if necessary .The local treatment included laser photocoagulation ,freezing,transpupillary thermotherapy,local radiotherapy of Ru106 applicator,extraction of eyeball,etc.The patients were visited within 3~61 months and the average follow-up visit period was 31months.The survival rate,the retention rate of eyeball and clinical efficacy was observed .Results The survival rate was 84.21%(16 cases).For 23 eyes,the retention rate of eyeball at Stage Ⅰ~Ⅱ,Ⅲ~ⅣandⅤwas 100.00%,40.00%and 16.67%.There were 3 dead ca-ses at stage Ⅳor above.Conclusion For retinoblastoma patients ,the systemic chemotherapy combined with local treatment has a higher clinical efficacy and higher retention rate of eyeball upon early treatment .