争鸣
ENGLISH ABSTRACT
玻璃体切割术治疗眼内恶性肿瘤的热点与争议
高静歌
Chen Danian
作者及单位信息
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DOI: 10.3760/cma.j.cn115989-20200311-00165
Controversy of vitrectomy in the treatment of intraocular malignancy
Gao Jingge
Chen Danian
Authors Info & Affiliations
Gao Jingge
Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
GaoJingge is now working at Wangjiang Hospital of Sichuan University, Chengdu 610065, China
Chen Danian
Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Health System, Departments of Ophthalmology and Vision Science, Laboratory Medicine and Pathology, University of Toronto, Toronto M5G IX5, Canada
·
DOI: 10.3760/cma.j.cn115989-20200311-00165
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摘要

视网膜母细胞瘤(RB)是婴幼儿最常见的原发性眼内恶性肿瘤,而脉络膜黑色素瘤是成人眼部最常见的原发性恶性肿瘤。随着眼内肿瘤诊断和治疗方法和技术的不断进步,患者的生存率显著提高,生存时间明显延长,眼内恶性肿瘤治疗目的也从单纯的挽救患者生命逐渐转变为在挽救生命的基础上尽量保全眼球。尽管目前眼内恶性肿瘤的治疗方案多样,但是对于部分难治性肿瘤,达到保全眼球的目标仍然具有很大挑战。近年来随着手术设备和操作技术的改进,玻璃体切割术再次成为难治性眼内期RB及脉络膜黑色素瘤的治疗方法之一,为这些眼内恶性肿瘤患者保全眼球带来了希望。然而,这种疗法仍有一定的并发症,因此存在争议,在治疗过程中一定要谨慎选择病例,小心实施手术,积极结合其他化学疗法和/或放射治疗及局部治疗方案,并且严密随访。

视网膜母细胞瘤;脉络膜黑色素瘤;玻璃体切割术;肿瘤复发;肿瘤转移;争议
ABSTRACT

Retinoblastoma (RB) and choroidal malignant melanoma are the most common primary intraocular malignancy in children and adults, respectively.Due to the advance in the diagnosis and treatment of intraocular tumors, the survival rate and survival time of the patients are significantly improved.The goal of the therapy for the patients of intraocular malignant tumors has gradually changed from simply saving life to trying to preserve eyeball on the basis of saving life.Although there are various treatment options for intraocular malignant tumors, eye salvage is still an great challenge for the patients with refractory tumors.In recent years, vitrectomy has been used again by some doctors to the treatment of refractory RB and choroidal malignant melanoma, which undoubtedly gives the hope of eye salvage to the patients with intraocular malignant tumors.However, this therapy arouse controversy because serious intraoperative or postoperative complications occurred in some patients.Ophthalmologists should select suitable indications for this surgery cautiously, perform the operation carefully, combine other chemotherapy and/or radiotherapy and local treatment and close follow-up if necessary.

Retinoblastoma;Choroidal malignant melanoma;Vitrectomy;Tumor recurrence;Tumor metastasis;Controversy
引用本文

高静歌,Chen Danian. 玻璃体切割术治疗眼内恶性肿瘤的热点与争议[J]. 中华实验眼科杂志,2021,39(03):249-253.

DOI:10.3760/cma.j.cn115989-20200311-00165

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眼内恶性肿瘤包括原发性肿瘤及转移性肿瘤,好发部位为视网膜和葡萄膜。婴幼儿的原发性眼内恶性肿瘤以视网膜母细胞瘤(retinoblastoma,RB)最为常见,成人中则以脉络膜黑色素瘤最为常见。RB是来源于光感受器前体细胞的恶性肿瘤,且患者就诊时多处于疾病晚期,严重威胁患儿的视力和生命。据统计,每年全球范围新发RB患者约9 000例,其中中国新发患者约1 100例 [ 1 , 2 ]。在过去的一百多年间,RB的治疗方法多采用眼球摘除术以最大限度保全患者生命,给患者及其家属带来沉重的经济和心理负担。近几十年来随着对RB发生机制和细胞生物学行为认识的加深,越来越多的新方法和技术逐渐用于RB的治疗,患者的生存率和眼球保留率均明显改善 [ 3 ]。然而,对于顽固的玻璃体腔种植瘤,现有的治疗方法疗效依然有限,要保全患者的眼球仍然面临巨大挑战。脉络膜黑色素瘤好发于白种人 [ 4 ],恶性程度高,瘤体血供丰富,且黑色素瘤细胞易通过血液转移,眼球摘除后5年死亡率仍高达15%~53% [ 5 , 6 , 7 ],其原因可能为黑色素瘤细胞的血行转移在眼球摘除术前就已经发生。因此脉络膜黑色素瘤常采用保守疗法,如局部放射敷贴、经瞳孔温热疗法以及光动力疗法等。以往玻璃体切割术曾用于RB和脉络膜黑色素瘤的治疗中,但由于存在术中或术后严重并发症而备受争议,限制了该疗法的应用。近年来,随着眼内恶性肿瘤治疗方法的拓展及玻璃体手术设备和技术的进步,玻璃体切割术再次尝试作为保眼措施的联合方案用于眼内恶性肿瘤的治疗,但手术治疗的风险仍然是关注的热点。
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Danian Chen, Email: mocdef.qabq6002nehcnainad
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所有作者均声明不存在任何利益冲突
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国家自然科学基金项目 (81870665)
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