脉络膜黑色素瘤眼球保留治疗结果初步观察

Therapeutic effects of eye-retaining treatment for choroidal melanoma

目的观察保留眼球的治疗法治疗脉络膜黑色素瘤的临床效果。方法回顾分析44例脉络膜黑色素瘤患者44只患眼接受眼球保留治疗的临床资料，观察分析全身转移情况、眼球保留率以及视力预后。患者均为单眼发病，其中，以经瞳孔温热疗法（TTT）作为首选治疗者7只眼，占15．9％；以^106Ru放射敷贴器近程放射治疗为首选治疗者25只眼，占56．8％；肿瘤切除联合^106Ru放射敷贴器近程放射治疗者12只眼。占27．3％。治疗后随诊观察时间平均为13．3个月。结果44例患者在观察期内均未出现肿瘤全身转移。39例成功保留眼球，占88．6％。6只小肿瘤眼、14只中等大肿瘤眼和24只大肿瘤眼的眼球保留率分别为100％、92．9％和83．3％。11只眼视力≥0．3，占28．2％；18只眼视力≥0．05～〈0．3，占46．2％；10只眼视力〈0．05，占25．6％。结论^106Ru放射敷贴器近程放射治疗和TTT治疗可以有效治疗中、小脉络膜黑色素瘤；部分大肿瘤选择肿瘤切除联合^106Ru放射敷贴器近程放射治疗，其综合效果是否优于眼球摘除手术尚需进一步观察。

Objective To evaluate the therapeutic effects of treatments of eye-retaining and enucleation for choroidal melanomas. Methods The clinical data of 44 patients （44 eyes） with choroidal melanomas after eye-retaining treatments and enucleation surgery were retrospectively analyzed. The metastasis, retention rate of eyeball after eye-retaining treatment, and visual acuity prognosis were observed and analyzed. In 44 eyes treated by eye-retaining therapy, transpupillary thermotherapy （TTT） was performed primaryly on 7 （15.9%）,^106Ru brachytherapy on 25 （56.8%）, and local resection of tumor combined with ^106Ru brachytherapy on 12 （27.3%）. The average follow-up period was 13.3 months. Results Forty-four patients had no melanoma metastasis during the follow-up period. In 39 patients （88.6%） who had their eyes retained successfully, the retention rate of eyeball was 100%, 92.9%, and 83.3% in 6, 14, and 24 eyes with small, middle, and large tumor, respectively. In the patients treated by eye-retaining therapy, the visual acuity was ≥0.3in 11 （28.2%）, ≥0.05-〈50.3in 18 （46.2%）, and 〈5 0.05 （25. 6%） in 10 eyes. Conclusions ^106Ru brachytherapy and transpupillary thermotherapy are effective treatments for small- and medium-sized choroidal melanomas; some selected cases with large choroidal melanomas was treated with local resection of tumor combined with ^106Ru brachytherapy. However, longer follow-up will be necessary to assess if this treatment has a better comprehensive outcome, compared with enucleation surgery.