脉络膜转移癌的临床特点分析

目的 分析脉络膜转移癌的临床特点以指导治疗.方法 回顾性系列病例研究.收集脉络膜转移癌患者49例(66只眼),均行眼底检查,其中44例行荧光素眼底血管造影检查,12例合并吲哚氰绿造影检查,8例行B超检查.采用经瞳孔温热疗法(TTT)24只眼,联合光敏治疗1只眼.眼敷贴放疗1只眼.,TTT采用的治疗参数为光斑1.2～3.0mm,能量450～1000 mV,时间60 s.做2次TTT者2例,做3次TTT者1例.结果患者中男性14例,女性35例.双眼17例(34.7%).年龄23～74岁,平均47岁.视力小于或等于0.05者13只眼,0.06～0.2者22只眼,大于等于0.3者31只眼.已发现原发肿物40例(81.6%)(行手术切除术25例).其中患乳腺癌16例(32.7%),肺癌(包括支气管1例)14例(28.6%),肝胆肿物3例,结肠癌及胃癌3例,妇科附件肿物2例,鼻咽癌l例(含卵巢黏液囊性腺癌1例),脊柱骨肿物1例,尚未查明原发肿物5例(10.2%),4例尚在检查中.眼底有1个转移灶者58只眼(87.8%).2个转移灶者4只眼(6%).3个及以上转移灶2只眼(包括7个灶1例).根据眼底转移灶所在部位及发展情况,将转移灶分为孤立型,39只眼,占59%(39/66);弥漫型,19只眼,占28.8%(19/66);早期型,8只眼,占12.1%(8/66).荧光素眼底血管造影检查可见早期转移灶处呈低荧光,晚期灶处荧光融合呈中等或强荧光.对8例孤立型转移灶行B超测量,其平均值约为11.5 mm×10.5 mm×3.6 mm,瘤体最高可达4.9 mm.作敷贴放疗的患者1例,观察3个月,瘤体变扁平,维持原视力.作TTT治疗后3例随访各为4、3、2个月.病变稳定,视力不变或轻度下降.结论脉络膜转移癌有其临床特点.眼底病变分型有助于对病情的了解.在全身治疗情况下,埘眼部孤立型及早期型转移灶采用TTT治疗,可使病灶消退,保护视力,对提高患者生活质量有较大帮助.(中华眼科杂志,2009,45:229-233)

Clinical features and treatment of choroidal metastasis

Objective To assess the clinical features and management of choroidal metastasis.Methods Fundus examination was performed in 49 patients(66 eyes)with choroidal metastasis.Fundus fluorescein angiography(FFA)Was performed in 44 cases,combined with indocyanine green angiography(ICGA)examination in 12 cases.B-scan ultrasound examination was performed in 8 cases.Transpupillary thermotherapy(TTT)was performed in 24 eyes,combined with photo-dynamic therapy in one eye.Plaque radio-therapy Was used in one eye.The parameters of treatment for TTT were 1.2-3 mm spot size,450-1000 mV,60 s;2 sessions of TTT in 2 eyes and 3 sessions in 3 eyes.Results Fourteen cases were male and 35 cases were female.Both eyes were affected in 17 cases(34.7%).Age ranged from 23-74 years old with an average of 47 years.The visual acuity Was 0.05 or less in 13 eyes:0.06-0.2 in 22 eyes and 0.3 or more in 31 eyes.Primary tumours were found in 40 cases(81.6%)(surgical excision in 25 cases),consisting of breast carcinoma in 16 cases(32.7%),lung carcinoma in 14 cases(28.6%),hepatoma and cholangiocarcinoma in 3 cases,colon and stomach carcinomas in 3 cases,gynecologic appendix carcinoma(including 1 case of ovarian mucous cyst adenocarcinoma)in 2 cases,nasopharyngeal adenocarcinoma in 1 case,vertebra tumor in 1 case,undetected in 5 cases(10.2%)and under detection in 4 cases(8.2%).The fundus had 1 lesion in 58 eyes(58/66=87.8%),2 lesions in 4 eyes(4/66=6.0%),3 or more lesions in 2 eyes(including 7 lesions in 1 eye).According to the location and development status of the lesions,they could be divided into solitary type,39 eyes(39/66=59.1%);diffuse type,19 eyes(19/66=28.8%);and early type,8 eyes(8/66=12.1%).FFA examination:early stage lesions showed hypofluorescence and later stage lesions showed moderate to strong hyperfluorescence.In 8 cases of solitary lesions,the size of the lesion measured by B-scan averaged 11.5 mm×10.5 mm×3.6 mm with the maximal heiisht at 4.9 mm.The tumor became flattened and vision remained stable at 3 months after plaque radiotherapy in 1 case.Three case6 were followed-up for 2,3,and 4 months after TTT treatment.The lesions remained stable with vision unchanged or slightly decreased.Conclusions The choroidal metastasis has specific clinical features.The classification of metastatic lesions into solitary,diffuse and early types is helpful for the evaluation of the disease process.The primary tumor can be found in 80% of cases.The most common primary cancer is breast carcinoma,followed by lung carcinoma.These two cancers account for 75% of primary tumors.In solitary type and early type lesions,TTT combines with systemic treatment could result in regression of lesions,saving of vision and improvement of the life quality.(Chin J Ophthalmol,2009,45:229-233)