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要約 目的:メルファランの眼動脈注入による網膜芽細胞腫の治療報告。対象:過去18か月間に網膜芽細胞腫で眼球保存療法の適応があると判断した7例10眼を対象とした。男児2例,女児5例であり,4例が片眼性,3例が両眼性であった。年齢は1か月~1年8か月(中央値1年4か月)であった。Reese-Ellsworth分類による病期は,Ⅰbが3眼,Ⅱaが4眼,Ⅲbが1眼,Ⅴbが2眼であった。方法:初回治療としてVECによる全身化学療法を2コース行い,以後は眼底所見に応じて,メルファランの眼動脈と硝子体注入,経瞳孔的温熱療法,ルテニウムの強膜縫着,眼球摘出を行った。結果:10か月間に31回の選択的眼動脈注入を10眼すべてに行った。転帰は治癒5眼,治癒見込1眼,治療中2眼,眼球摘出2眼であり,合併症はなかった。結論:メルファランの眼動脈注入による網膜芽細胞腫の治療は,全身への影響が少なく,入院期間が短縮され,安全で有効な眼球保存療法である。
Abstract. Purpose:To report treatment of retinoblastoma with selective injection of melphalan into the ophthalmic artery. Cases:This study was made on 10 eyes of 7 cases of retinoblastoma who received conservative treatment during the past 18 months. The series comprised 2 males and 5 females. Retinoblastoma was unilateral in 4 cases and bilateral in 3. The age ranged from one to 20 months, median 16 months. Stage of retinoblastoma was Ⅰb 3 eyes, Ⅱa 4 eyes, Ⅲb one eye, and Ⅴb 2 eyes. Method:All the cases received, initially, 2 courses of VEC(vincristine, etoposide and carboplatine). Following treatments were performed depending on the fundus findings:injection of melphalan into the ophthalmic artery and vitreous, transpupillary thermotherapy, brachytherapy with ruthenium, or enuculeation. Results:Injection of melphalan was performed in 10 eyes in 31 sessions during a 10-month period. Cure was obtained in 5 eyes, was expected in one eye, 2 eyes were still under treatment, and enucleation was performed on 2 eyes. Complication was absent throughout. Conclusion:Selective injection of melphalan into the ophthalmic artery is safe and effective for retinoblastoma with minimum systemic side effects and short hospitalization.
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