经眼动脉灌注美法仑和卡铂治疗视网膜母细胞瘤的疗效观察

Efficacy of ophthalmic artery infusion of melphalan combined with carboplatin in the treatment of retinoblastoma

目的 探讨经眼动脉灌注美法仑和卡铂治疗视网膜母细胞瘤(Rb)的临床疗效。方法 回顾性选取2020年12月至2021年12月间西安宝石花长庆医院收治的76例(93眼)Rb患儿,依据化疗方式的不同分为经眼动脉灌注化学治疗(IAC)组44例和经静脉全身化学治疗(IVC)组32例,比较两组患儿的保眼率、肿瘤复发率、生存率、并发症发生情况及化疗前后瘤体变化情况。结果 化疗后,两组患儿瘤体最大径和瘤体厚度均降低,且IAC组均低于IVC组,差异均有统计学意义(均P<0.05)。IAC组患儿保眼率高于IVC组,差异有统计学意义(P<0.05);两组患儿复发率、转移率和致死率比较,差异均无统计学意义(P>0.05)。两组患儿白内障和玻璃体出血发生率比较,差异无统计学意义(P>0.05);IAC组患儿眼球内陷、眼睑水肿和眼睑下垂发生率均高于IVC组,发热和骨髓抑制发生率均低于IVC组,差异均有统计学意义(均P<0.05)。结论 Rb患儿发病年龄较小且多进展至晚期,采用IAC方案治疗能够有效改善瘤体情况,提高保眼率,但需注意化疗引起的眼球局部并发症,以更好改善患儿视力及生存质量。

Objective To investigate the efficacy of ophthalmic artery infusion of melphalan combined with carboplatin in the treatment of retinoblastoma(Rb). Methods The clinical data of 76(93 eyes) Rb children admitted to Xi’an Gemstone Changqing Hospital were retrospectively analyzed from December 2020 to December 2021. They were categorized into an intraophthamic artery chemotherapy(IAC) group(44 children) and an intravenous systemic chemotherapy(IVC) group(32 children). The eye conservation rate, tumor recurrence rate, survival rate and incidence of complications were compared between the two groups, and the changes in tumor body before and after chemotherapy were compared between the two groups. Results After chemotherapy, the largest tumor diameter and tumor thickness decreased in both groups with the IAC group significantly lower than the IVC group(all P<0.05). The eye conservation rate was significantly higher in IAC group than in IVC group(P<0.05). There was no significant difference in recurrence rate, metastasis rate and fatality rate between the two groups(P>0.05). There was no significant difference in the incidence of cataract and vitreous hemorrhage between the two groups(P>0.05). The incidence of enophthalmos, eyelid edema and blepharoptosis was higher and the incidence of fever and bone marrow suppression were lower in IAC group than in IVC group(all P<0.05). Conclusion Children with Rb onset are mostly very young and are mostly advanced to advanced stages. IAC treatment can effectively improve tumor body and improve eye conservation rate and quality of life.