摘要
目的:评估晚期视网膜母细胞瘤(RB)眼球摘除术前眼底照相检查中视盘遮蔽与眼球摘除术后视神经侵犯程度的相关关系。方法:回顾性系列病例研究。收集2012年1月1日至2015年12月31日在北京大学人民眼科诊断为RB且分期为D期或E期并进行眼球摘除术的77例(77只眼)患者资料,所有患者均在眼球摘除术前首次诊断及随后每3周1次复查时全身麻醉下使用RetCam眼底照相机拍摄眼底图像,记录视盘遮蔽(眼底像中视盘结构完全不可见)情况。眼球摘除术后以组织病理学诊断是否出现肿瘤侵犯筛板前视神经、肿瘤侵犯筛板后视神经和视神经断端存在肿瘤组织为主要观察指标。比较视盘遮蔽患者与视盘可见患者间肿瘤组织视神经侵犯程度及高危病理因素。采用χ2检验进行统计学分析。结果:77例患者中男性46例,女性31例,首次诊断RB年龄为(27.1±22.1)个月。首次诊断RB时77只患眼中62只眼(80.5%)存在视盘遮蔽。29只眼(37.7%)为首次诊断后即进行眼球摘除术;48只眼(62.3%)为首次诊断后先行保眼治疗后行眼球摘除术。77只眼行眼球摘除术前末次眼底照相时,16只眼(20.8%)视盘可见,61只眼(79.2%)存在视盘遮蔽;14只眼(18.2%)分期为D期,63只眼(81.8%)分期为E期。眼球摘除术后眼球组织病理学检查结果显示,术前末次眼底照相视盘可见的16只患眼中肿瘤侵犯筛板前视神经、肿瘤侵犯筛板后视神经和视神经断端存在肿瘤组织分别有7、2、0只眼,61只视盘遮蔽患眼中分别有26、9、4只眼,二者比较差异均无统计学意义(P=0.935,1.000,0.296)。48只眼保眼治疗期间,40只眼视盘遮蔽情况无变化或由遮蔽变为可见,其中10只眼术后眼球组织具有高危病理因素;8只眼视盘由可见变为遮蔽,其中1只眼术后眼球组织具有高危病理因素,二者比较差异无统计学意义(P=0.529)。结论:晚期RB患者眼底照相中视盘遮蔽情况与组织病理学结�
Objective To evaluate the potential association between optic nerve invasion and optic nerve obscuration during treatment of advanced retinoblastoma.Methods Retrospective case series study.Medical records of 77 patients(77 eyes)with advanced retinoblastoma(Group D/E)who were treated with primary or secondary enucleation in the Ophthalmology Department of Peking University People′s Hospital from January 1st 2012 to December 31th 2015 were retrospectively reviewed.RetCam photographs under general anesthesia at diagnosis and each subsequent follow-up were evaluated for complete obscuration of the optic nerve.The primary endpoints included prelaminar invasion,postlaminar invasion and optic nerve transection invasion.Group difference was calculated with chi-square.Results There were 46 boys and 31 girls in the study.The mean age at the first diagnosis was(27.1±22.1)months.The optic nerve was obscured in 62 eyes(80.5%)at the first diagnosis and 61 eyes(79.2%)at the last ocular examination prior to enucleation.Twenty-nine eyes(37.7%)underwent primary enucleation.Forty-eight eyes(62.3%)were treated with eye-preserving therapy,followed by enucleation.Fourteen eyes(18.2%)were in Group D and 63 eyes(81.8%)were in Group E.Histopathologic analysis of enucleated eyes without optic nerve obscuration(16 eyes)showed prelaminar invasion in 7 eyes,postlaminar invasion in 2 eyes and optic nerve transection invasion in 0 eyes.Histopathologic analysis of enucleated eyes with optic nerve obscuration(61 eyes)showed prelaminar invasion in 26 eyes,postlaminar invasion in 9 eyes and optic nerve transection invasion in 4 eyes.The difference between two groups did not achieve statistical significance(P=0.935,1.000,0.296).Histopathologic analysis of enucleated eyes with persistent complete obscuration of the optic nerve showed a high risk factor in 10 eyes(10/40),while in 1 eye(1/8)the optic nerve was visible at the initial presentation and obscured before secondary enucleation(P=0.529).Conclusion Optic nerve obscuration at the last examin
作者
邓洵
程湧
朱雪梅
令狐丹丹
赵明威
梁建宏
Deng Xun;Cheng Yong;Zhu Xuemei;Linghu Dandan;Zhao Mingwei;Liang Jianhong(Department of Ophthalmology,Peking University People′s Hospital,Eye Diseases and Optometry Institute,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases,College of Optometry,Peking University Health Science Center,Beijing 100044,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2020年第9期681-687,共7页
Chinese Journal of Ophthalmology
基金
北京市自然科学基金(2150000038)。
关键词
视网膜母细胞瘤
视盘
视神经
肿瘤侵润
Retinoblastoma
Optic disk
Optic nerve
Neoplasm invasiveness
