摘要
目的探讨以非“白瞳症”为主要表现的视网膜母细胞瘤（Rb）病例的诊断与鉴别诊断要点。方法同顾性分析1990～2006年间在北京同仁医院就诊的111例以非“白瞳症”表现Rb患儿的临床及组织病理学资料。结果此类患儿占同期Rb患儿总数的19．2％。患儿平均年龄为40．8个月，主要症状平均持续4．8个月。超过50％的患儿大于等于3岁，5岁及5岁以上的患儿占有相对较大的比例（23．4％）。就诊时的主要表现依次为视力下降（40．5％）、斜视（27．9％）、眼红肿痛（21．6％）、眼球变大（6.3％）、畏光流泪（4．5％）、眼球萎缩（3．6％），其他（11．7％）。组织病理学示73．9％的肿瘤位于眼球内，26．1％的肿瘤侵至眼球外，其中6只眼（5．4％）视神经断端受累。5只眼肿瘤发生自发退行，其中4例表现为眼球萎缩。结论临床中对不明原因（或伴反复发作）的视力下降、斜视、眼红肿痛、眼球变大或萎缩、眼内小血、畏光流泪的患儿应排除Rb的可能性。
Objective To discuss the main points of diagnosis and differential diagnosis of retinoblastoma patients with non-leukocoria as main symptoms.Methods The retrospective study included 111 patients seen in Eye Center of Beijing Tong Ren Hospital between January 1990 and December 2006,whose main complaints were not leukocoria.The medical records were reviewed,and the clinical manifestations and histopathological findings were evaluated.Results These patients accounted for 19.2% of all patients during this period.The age of patients averaged 40.8 months and the complaints lasted for a mean time of 4.8 months. Over 50% of patients were equal to or older than 3 years old and a relatively large percentage （23.4%）of patients were equal to or older than 5 years.The main symptoms at diagnosis were decreased vision （40.5%）, strabismus （27.9%）,ocular redness and swelling with or without pain （21.6%）,enlarged eyeball （6.3%）, photophobia and lacrimation （4.5%）,atrophy of eyeball （3.6%）,and others （11.7%）.Histopathological examination demonstrated that tumors were confined within the globe in 73.9% of patients and spread extraocularly in 26.1% ,and cut ends of the optic nerves were affected in 6 eyes （5.4%）.Tumors with spontaneous regression were found in 5 cases and all were in intraocular stage and 4 of these occurred atrophy of eyeball.The differential diagnoses mainly included strabismus,orbital inflammation,intraocular inflammation,glaucoma,intraocular hemorrhage, other disease that caused poor vision.Conclusions In the clinic, children who display poor vision, strabismus, ocular redness and swelling, enlargement or atrophy of the eyeball, intraocular hemorrhage, photophobia and lacrimation with unidentified reason or with repeated attack should be noticed and considered the possibility of retinoblastoma.
出处
《中国实用眼科杂志》
CSCD
北大核心
2008年第10期1131-1133,共3页
Chinese Journal of Practical Ophthalmology
