视网膜母细胞瘤眼内化学疗法的研究

The experimental study on intraocular chemotherapy for retinoblastoma

目的探讨视网膜母细胞瘤(Rb)眼内化学疗法的效果。方法88只荷瘤兔眼,按兔眼前房内Rb肿物大小及眼内化学疗法剂量和途径随机分为11组(包括对照、前房注射、结膜下注射及全身注射组),每组8只眼,眼内化学疗法后每天观察兔眼局部及全身情况,30d处死动物,做常规病理学检查,并分析前房内肿物治愈率或控制率及治愈时间等。结果眼内化学疗法组兔眼前房内肿物治愈率均为100%。前房内肿物消失时间、肿物高度相同而化学疗法剂量不同的各组之间,以及化学疗法剂量相同而肿物高度不同的各组之间的差异具有统计学意义(P<0.05)。结膜下注射组及全身注射组兔眼前房内肿物治愈率均为0%,只有不同程度的前房内肿物控制。结论眼内化学疗法与结膜下注射及静脉注射化学疗法相比治愈率较高;眼内化学疗法的效果与肿物的大小及化学疗法时所采用的药物质量浓度有关。

Objective Many managements for retinoblastoma（Rb） were reported to be effective in clinic. But the better treating approach is worth studying. The purpose of this study was to explore the effectiveness of intraocular chemotherapy for Rb. Methods Eighty-eight rabbit eyes with Rb of anterior chamber were divided into 11 groups randomly based on tumor size,dose and approach of etoposide and 8 rabbits for each group. Different dose of cyclophosphamide or cyclosporin A was systemically or topically used in different model groups prior to the administration of etoposide. The administering approach of etoposide included subconjunctival injection,intravenous injection and intra-anterior-chamber injection. 0. 1 mL of normal saline solution was injected into anterior chamber in 8 rabbit eyes with Rb of anterior chamber as control group. After administered of etoposide, the tumor change,ocular manifestations and systemic status were clinically observed every day. The rabbits were killed on the 30th day for histopathological examination under the light microscope. The disappearing rate and control rate of ocular tumor were analyzed. Results The disappearing rate of tumor in intraocular chemotherapy group（ intra-anterior-chamber injection） was 100% ,but that of subconjunctival injection group and intravenous injection group was 0. Intraocular tumors were controlled to different extent in subconjunctival injection group and intravenous injection group. The tumor disappeared within 30 days and no the metastasis of tumor was found in intraocular chemotherapy group. The treating effectiveness of chemotherapy to tumor was better in the higher dose drug group and smaller tumor group. Conclusion Intra-anterior-chamber injection of etoposide is the better approach to the treatment of anterior chamber Rb in comparison with subconjunctival injection and intravenous injection, but the effect of intraocular chemotherapy can be affected by the size of the intraocular tumor and drug dose.