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[前葡萄膜恶性黑色素瘤的外科治疗结果]

[Results of surgical treatment for anterior uveal malignant melanoma].

作者信息

Zygulska-Mach H, Słomska J

机构信息

Katedry i Kliniki Okulistyki Akademii Medycznej im. M. Kopernika, Krakowie.

出版信息

Folia Med Cracov. 1991;32(3-4):219-25.

PMID:1845319
Abstract

The authors observed for 5 to 18 years 41 patients (22 women and 19 men) with malignant iris melanoma and/or malignant melanoma of ciliary body. The age of the patients was 20 to 80 years. All patients underwent surgical treatment with preservation of the eye ball. In 21 cases iridectomy, in 18 cases iridocyclectomy, and in the remaining cases iridocyclectomy-choroidectomy was performed. In 25 eyes the tumour occupied less than 1/4, and in 16 eyes between 1/4 and 1/2 of the iris circumference. During the period of observation 7 eye balls were enucleated, and in 6 recidivation of the tumour was diagnosed. These patients belonged to the group of 18 people with the tumour occupying the iris and the ciliary body, or the ciliary body only. Mortality in this group was 28%. Among 5 patients who died, in 3 the tumour occupied more than 1/4 of the iris circumference. In 3 patients from this group recidivation was diagnosed, in 4 enucleation was necessary. In 4 eyes secondary glaucoma was diagnosed. Therefore, among risk factors one ought to list size of the tumour, recidivation, and secondary glaucoma. On the other hand infiltration of the sclera and of the optic nerve was found only in one deceased person. The authors have not been able to obtain current information about 2 patients. In the whole studied group mortality was 5 out of 39, that is 12.8%. The most common complication during the surgery was hemorrhages. Two other complications: complicated cataract, usually stationary, and secondary glaucoma occurred both before and after treatment. Despite of complications 68.3% of patients maintained good visual acuity.

摘要

作者对41例(22名女性和19名男性)患有虹膜恶性黑色素瘤和/或睫状体恶性黑色素瘤的患者进行了5至18年的观察。患者年龄在20至80岁之间。所有患者均接受了保留眼球的手术治疗。21例行虹膜切除术,18例行虹膜睫状体切除术,其余病例行虹膜睫状体脉络膜切除术。25只眼中肿瘤占据虹膜圆周不到1/4,16只眼中肿瘤占据虹膜圆周的1/4至1/2。在观察期间,7只眼球被摘除,6例被诊断为肿瘤复发。这些患者属于肿瘤占据虹膜和睫状体或仅占据睫状体的18人组。该组死亡率为28%。在死亡的5例患者中,3例肿瘤占据虹膜圆周超过1/4。该组中有3例被诊断为复发,4例需要摘除眼球。4只眼被诊断为继发性青光眼。因此,在风险因素中应列出肿瘤大小、复发和继发性青光眼。另一方面,仅在1例死亡患者中发现巩膜和视神经浸润。作者未能获得2例患者的最新信息。在整个研究组中,39例中有5例死亡,即12.8%。手术期间最常见的并发症是出血。另外两种并发症:复杂白内障,通常为静止性,以及继发性青光眼在治疗前后均有发生。尽管有并发症,68.3%的患者仍保持良好视力。

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