摘要目的 观察巩膜表面敷贴放射(PRT)联合经瞳孔温热疗法(TTT)治疗脉络膜黑色素瘤(CM)的治疗效果.方法 采用国产巩膜敷贴器联合TTT对30例CM患者的30只眼进行治疗.其中,男性15例,女性15例;均为单眼.视力0.1～0.8,平均视力0.3±0.2.肿瘤最大基底径6.80～17.90 mm,平均最大基底径(11.30±2.80)mm;高度3.90～10.60 mm,平均高度(7.20±2.40)mm.肿瘤局部控制标准:对比B型超声测量下的肿瘤大小,若肿瘤高度增加2.00 mm或肿瘤任意一边界扩展0.25 mm视为肿瘤生长.治疗后随访15～57个月,平均随访时间(33.01±9.81)个月,观察肿瘤局部控制率、眼球保存率、治疗后视力以及治疗后并发症的发生情况.结果 治疗后肿瘤最大基底径4.60～17.00 mm,平均最大基底径为(9.79±3.35)mm.与治疗前肿瘤平均最基底径比较,差异有统计学意义(t=2.195,F=0.49;P=0.032);肿瘤高度为2.70～11.90 mm,平均高度(5.19±2.57)mm.与治疗前肿瘤平均高度比较,差异有统计学意义(t=2.069,F=0.018;P=0.043).末次随访时,肿瘤最大基底径较治疗前最大基底径增加2只眼;肿瘤高度较治疗前肿瘤高度增加2只眼.肿瘤局部控制率为86.7%.治疗后眼球摘除3只眼,眼球保存率为90.0%.视力保持稳定12只眼,占40.0%;视力提高1只眼,占3.3%;视力下降17只眼,占56.7%.出现放射性视网膜病变12只眼,占40.0%;继发性视网膜脱离3只眼,占10.0%,其中伴有继发性青光眼1只眼;白内障4只眼,占13.3%;干眼症症状5只眼,占16.7%.结论 PRT联合TTT能有效控制肿瘤生长,并发症发生率低.

abstractsObjective To observe the therapeutic efficacy and complications of plaque radiotherapy (PRT) combined with transpupillary thermotherapy (TTT) on choroidal melanoma (CM). Methods Thirty unilateral CM patients (30 eyes, including 15 males and 15 females) were treated by PRT and TTT.The visual acuity ranged from 0. 1 to 0. 8 with an average of 0. 3 ± 0.2. The largest base diameter of tumor ranged from 6. 8 mm to 17. 9 mm with an average of (11.3±2.8) mm;The tumor height ranged from 3.9mm to 10.6 mm with an average of (7.2±2.4) mm. The criteria of controlled local tumor: based on B-scan ultrasound measurement, the tumor was considered as "growing" if tumor height increased 2 mm or tumor largest base diameter increased 250 μm, otherwise the tumor was considered "controlled". The follow-up ranged from 15 to 57 months with an average (33.01 ± 9. 81) months. The local tumor control rate,enucleation rate and visual acuity, complications after treatment were observed. Results The tumor largest base diameter after treatment ranged from 4.6 mm to 17.0 mm with an average (9.79±3.35) mm, which had statistically significant difference(t=2. 195,F=0.49;P=0. 032) with that before treatment. The tumor height after treatment ranged from 2.7 mm to 11.9 mm with an average (5.19±2.57) mm, which had statistically significant difference(t = 2. 069, F= 0. 018;P = 0. 0435 ) with that before treatment. At the end of follow up, the tumor largest diameter and height increased in two eyes respectively compared with those before treatment. Local tumor control rate was 86.7 %. Three eyeballs were enucleated after treatment, the enucleation rate was 10. 0%. The visual acuity remained unchanged in 12 eyes, improved in one eye and decreased in 17 eyes. Treatment complications included radiation retinopathy in 12 eyes (40.0%),secondary retinal detachment in three eyes (10. 0 % ), secondary glaucoma in one eye (3.3 % ), cataract in four eyes (13.3%) and dry eye syndrome in five eyes (16.7%). Conclusion PRT combined with TTT is an effective therapy for choroidal melanoma with less complications.