葡萄膜肿瘤切除术。
Uveal tumour resection.
作者信息
Char D H, Miller T, Crawford J B
机构信息
The Tumori Eye Foundation, CPMC Davies, Stanford University, CA 94114, USA.
出版信息
Br J Ophthalmol. 2001 Oct;85(10):1213-9. doi: 10.1136/bjo.85.10.1213.
AIM
To review the ocular retention rates, visual results, and metastases in uveal tumours managed with eye wall resection techniques.
METHODS
This was a retrospective analysis of consecutive local uveal tumour resections performed by a single surgeon. All enucleation specimens were reviewed by one author. Both parametric and non-parametric analysis of data were performed.
RESULTS
138 eyes were scheduled for eye wall resection surgery. The mean age was 52 years (range 11-86 years). Tumours involved predominantly the iris in 14 cases, iris-ciliary body in 57, ciliary body alone in 18 patients, and in 49 cases the choroid was involved (ciliochoroidal, iris-ciliary body-choroid, or choroid). 125 eyes harboured melanomas; posterior tumours were more likely to have epithelioid cells (p<0.05). The mean follow up was 6 years. The mean clock hours in iris and iris-ciliary body tumours was 3.5. In tumours that involved the choroid the mean largest diameter was 12.9 mm and the mean thickness 8.5 mm. 105 of 138 (76%) eyes were retained. Histological assessment of surgical margins did not correlate evidence of tumour in enucleated eyes or metastatic disease. Surgical margins of more anterior tumours were more likely to be clear on histological evaluation (p<0.05). Approximately 53% of retained eyes had a final visual acuity of > or =20/40; visual results were significantly better in more anteriorly located tumours (p<0.05). All retained iris tumour cases had > or =20/40 final visual acuity. In tumours that involved the choroid nine of 31 retained eyes kept that level of visual acuity. Eight patients developed metastases; all metastatic events developed in patients with tumours that involved the choroid, and seven of eight were mixed cell melanomas.
CONCLUSIONS
76% of eyes were retained and 53% of these had a final visual acuity of > or =20/40. Only 7% of uveal melanoma patients developed metastatic disease with a mean follow up of 6 years. Survival did not appear to be compromised with eye wall resection and in very thick, more posterior melanomas it appeared that ocular retention and visual results were better than with radiation alone.
目的
回顾采用眼壁切除术治疗葡萄膜肿瘤的眼球保留率、视觉效果及转移情况。
方法
这是一项对由单一外科医生连续进行的局部葡萄膜肿瘤切除术的回顾性分析。所有眼球摘除标本均由一位作者进行检查。对数据进行了参数分析和非参数分析。
结果
138只眼计划接受眼壁切除手术。平均年龄为52岁（范围11 - 86岁）。肿瘤主要累及虹膜14例，虹膜睫状体57例，单纯睫状体18例，脉络膜49例（睫状脉络膜、虹膜睫状体脉络膜或脉络膜）。125只眼患有黑色素瘤；后部肿瘤更易出现上皮样细胞（p<0.05）。平均随访时间为6年。虹膜和虹膜睫状体肿瘤的平均钟点数为3.5。累及脉络膜的肿瘤平均最大直径为12.9mm，平均厚度为8.5mm。138只眼中有105只（76%）眼球得以保留。手术切缘的组织学评估与眼球摘除眼中的肿瘤证据或转移疾病无关。组织学评估显示，更靠前的肿瘤手术切缘更可能为阴性（p<0.05）。约53%的保留眼球最终视力≥20/40；更靠前位置的肿瘤视觉效果明显更好（p<0.05）。所有保留的虹膜肿瘤病例最终视力均≥20/40。在累及脉络膜的肿瘤中，31只保留眼球中有9只保持了该视力水平。8例患者发生转移；所有转移事件均发生在累及脉络膜的肿瘤患者中，8例中有7例为混合细胞黑色素瘤。
结论
76%的眼球得以保留，其中53%最终视力≥20/40。平均随访6年，只有7%的葡萄膜黑色素瘤患者发生转移疾病。眼壁切除似乎并未影响生存率，对于非常厚的、更靠后的黑色素瘤，眼球保留及视觉效果似乎优于单纯放疗。
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