特殊情况下视网膜母细胞瘤患儿的随访观察

Follow up of observation in patients with retinoblastoma under special circumstances

目的观察特殊情况下视网膜母细胞瘤(RB)复查患儿的肿瘤新发及复发情况。方法2020年1月25日至3月15日于河南省儿童医院眼科复诊的RB患儿30例42只眼纳入研究。其中,男性14例,女性16例;单眼18例,双眼12例。平均年龄(37.07±18.15)个月;平均初次诊断年龄(20.23±13.77)个月。有家族史2例(6.67%)。42只眼中,B、C、D、E期分别为7、8、20、7只眼。治疗结束、治疗中分别各为21只眼。患儿均行广角数码儿童视网膜成像系统、B型超声、眼眶MRI检查。观察不同治疗阶段患儿肿瘤有无新发或复发等情况。结果B期7只眼,治疗结束或治疗中患眼均无肿瘤复发或新发。C期8只眼,治疗结束患眼病情稳定;治疗中患眼新发肿瘤1只眼,肿瘤仍有活性1只眼。D期20只眼,治疗结束患眼肿瘤复发1只眼;治疗中患眼新发肿瘤3只眼,肿瘤仍有活性7只眼。E期7只眼,眼球摘除5只眼,肿瘤无复发,病情稳定;治疗中2只眼,肿瘤复发、仍有活性分别各为1只眼。单眼18只眼中,治疗中11只眼,新发肿瘤2只眼,肿瘤复发1只眼,肿瘤仍有活性3只眼;双眼24只眼中,治疗中10只眼,新发肿瘤3只眼,肿瘤仍有活性6只眼。治疗结束21只眼,平均要求复诊时间为(3.71±0.31)个月,平均延迟复诊时间为(6.43±1.66)周;肿瘤复发1只眼,发生率为4.76%。治疗中21只眼,要求复诊时间均为3周,平均延迟复诊时间为(6.00±1.89)周;新发肿瘤5只眼,发生率为21.74%;肿瘤仍有活性9只眼。结论RB患儿肿瘤分期风险越高,肿瘤复发和新发越多;治疗中患儿肿瘤复发或新发高于治疗结束患儿;治疗中双眼患儿肿瘤复发或新发高于单眼患儿。

Objective To observe the retinoblastoma(RB)reexamination of children with new and recurrence retinoblastoma under special circumstances.Methods From January 2,2020 to March 15,2020,30 children with RB who had fundus examination in Henan Children's Hospital were enrolled in this study.Among them,14 were male,16 were female;18 were monocular and 12 were binocular.The average age was 37.07±18.15 months.The mean age of initial diagnosis was 20.23±13.77 months.Two patients had a family history(6.67%).In 42 eyes,stage B,C,D and E were 7,8,20 and 7 eyes,respectively.Twenty-one eyes had finished the treatment course and 21 eyes were during treatment.All the children underwent RetCam fundus examination,orbital MRI,ocular B-ultrasound and so on.Whether the children had new tumor or recurrence at different treatment stages was observed.Results Among 7 eyes in stage B,there was no recurrence or new tumor at the end of treatment or in the process of treatment.Among 8 eyes in stage C,there were 1 eye with new tumor and 1 eye with activity tumor at the end of treatment.Among 20 eyes in stage D,there were 1 eye with recurrence tumor at the end of treatment,3 eyes with new tumor and 7 eyes with activity tumor at the end of treatment.Among 7 eyes in stage E,5 eyes had eyeball enucleation and 2 eyes were receiving treatment;there were 1 eye with activity tumor at the end of treatment,1 eye with recurrence tumor,1 eye with activity tumor.Among 18 monocular eyes,there were 11 eyes in the treatment process,2 eyes with new tumor,1 eye with recurrence tumor and 3 eyes with activity tumor.Of the 24 binocular eyes,10 were receiving treatment and there were 3 eyes with new tumor,6 eyes with activity tumor.Twenty-one eyes had finished the treatment course,the average time required for follow-up was 3.71±0.31 months,and the average time delayed for follow-up was 6.43±1.66 weeks.There was a recurrence of tumor in 1 patient who had finished the whole treatment,the incidence was 4.76%.In the course of treatment,21 eyes were required to have a follow-up time of 3 weeks,and the average delayed follow-up time was 6.00±1.89 weeks.There were 5 eyes with new tumors,with a incidence of 21.74%.Nine eyes still had activity and needed to be treated in time.Conclusions The higher the risk of tumor staging,the more relapses and new tumors.The patients who are being treated,the time of delayed follow-up,the higher the recurrence or new tumor than the children who have finished the treatment course and delayed the follow-up.The children who have relapsed or new tumor in the treatment course of binocular are higher than the children who have monocular.