摘要
目的评估选择性经眼动脉灌注化疗（SOAI）治疗视网膜母细胞瘤（RB）的临床疗效及安全性,探讨影响疗效的因素。方法回顾性分析2011年1月—2013年4月收治的RB患儿73例107只患眼行SOAI治疗的临床资料,并对术中灌注药物的种类、国际眼内RB肿瘤的分级、眼球供血的造影表现、术前的治疗史等因素与疗效的关系进行单因素和多因素分析。结果 343次眼动脉插管中,338次成功插至眼动脉,技术成功率为98.5%。患儿SOAI术后随访3-28个月,中位随访时间为13.6个月。术后84只眼瘤体完全消失,局部形成钙化斑块,总体保眼率为78.5%（84/107）;23只眼行眼球摘除术,包括肿瘤复发12例、广泛玻璃体种植4例、视网膜下种植3例、玻璃体出血4例。术后不良反应包括一过性的眼周不适及轻度骨髓抑制。经单因素和多因素分析结果显示,影响RB患儿保眼率的独立预后因素分别是国际眼内RB肿瘤的分级（P=0.04）、术中灌注药物的种类（P〈0.01）和术前的治疗史（P〈0.01）。结论SOAI是治疗RB的安全有效的方法 ,国际眼内RB肿瘤的分级、术中是否联合给药和术前治疗史可作为评估SOAI治疗RB的保眼率的重要指标。
Objective To evaluate the clinical efficacy and safety of selective ophthalmic arterial injection（SOAI） for the treatment of retinoblastoma（RB）, and to discuss the factors that influence the clinical outcomes. Methods The clinical data of 73 sick children with RB（107 diseased eyes in total）, who were admitted to authors＇ hospital to receive SOAI during the period from January 2011 to April 2013, were retrospectively analyzed. The kinds of the drugs used in SOAI, the international staging of RB, the angiographic manifestations of the blood supply of the eyeballs, the previous treatments before SOAI, etc.were recorded, and the their correlations with clinical curative effect were analyzed using univariate and multivariate analysis method. Results A total of 343 times of selective ophthalmic arterial catheterization were carried out, and the catheter was successfully inserted to the ophthalmic artery in 338 procedures with a technical success rate of 98.5%. After SOAI all sick children were followed up for 3-28 months, the median following- up time being 13.6 months. After SOAI, the tumor was completely disappeared in 84 eyes and localized calcification plaque was formed, and the overall ocular preservation rate was 78.5%（84/107）.Eyeball enucleation had to be carried out for 23 eyes due to tumor relapse（n =12）, diffuse implantation in vitreous（n=4）, subretinal implantation（n=3） and vitreous hemorrhage（n=4）. Postoperative adverse reactions included transient eye disco mfort and mild bone marrow suppression. Univariate and multivariate analysis showed that the independent prognostic factors affecting ocular preservation rate in sick children with RB were the international staging of RB（P =0.04）, the kind of the drug used in SOAI（P〈0.01） and the previous treatment before SOAI（P〈0.01）. Conclusion For the treatment of RB, SOAI is safe and effective. The international staging of RB, the kind of the drug used in SOAI and the previous treatment before SOAI are the important indexes for the prediction of ocular preservation rate.
出处
《介入放射学杂志》
CSCD
北大核心
2015年第12期1062-1066,共5页
Journal of Interventional Radiology
关键词
视网膜母细胞瘤
选择性经眼动脉灌注化疗术
多因素分析
美法仑
保眼率
retinoblastoma
selective ophthalmic arterial perfusion chemotherapy
multivariate analysis
melphalan
ocular preservation rate
