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目的 观察X刀立体定向放射治疗对脉络膜黑色素瘤的疗效及贯穿眼睑直肌牵拉眼球固定法的效果。方法 采用Vrian 2 10 0C直线加速器 ,6× 10 6VX刀对 16例 (16只眼 )瘤体为 11 8mm× 10 0mm× 4 5mm的脉络膜黑色素瘤患者进行立体定向放射治疗 (平均边缘剂量为 2 3 4Gy) ,观察其临床疗效 ,并对其进行评估。放疗前先将眼球固定 ,即局部浸润性麻醉 (不用球后注射 ) ,于 4条直肌附着处置牵引缝线 ,上下穹窿中部贯穿眼睑 ,分别固定于眉上、眶下缘、鼻根、眶外缘处深及骨膜。平均随访 18 5个月 (12～ 36个月 )。结果 瘤体于治疗后 6～ 12个月内明显缩小 7例 (43 8% ) ;1～ 2年时 ,11例 (6 8 8% )肿瘤缩小。其中 4例肿瘤处残留小盘状痕迹 ,3例肿瘤缩小不明显 ,3例肿瘤因有轻微增大而行眼球摘除术。瘤体局部控制率为 81 3%。除视网膜及其膜下可见小片状出血外 ,余无其他严重并发症。眼球固定良好 ,放疗定位准确。结论 脉络膜黑色素瘤的X刀立体定向放射治疗法效果较好 ,无严重并发症 ,瘤体局部控制率高。贯穿眼睑直肌牵拉固定眼球法效果可靠
Objective To observe the curative effect of X-knife stereotactic radiotherapy on choroidal melanoma and the effect of eyeball fixation through the eyelid muscle. Methods Stereotactic radiotherapy was performed in 16 patients (16 eyes) with choroidal melanoma of 11 8mm × 10 0mm × 4 5mm with a Vrian 2 10 0C linear accelerator and a 6 × 10 6 VX knife. The average marginal dose was 23 4Gy), observe its clinical efficacy, and its assessment. Before radiotherapy, the eyeballs were fixed, that is, local invasive anesthesia (without ball injection). The sutures were attached to the four rectus abdominis and the middle of the upper and lower vaults were penetrated through the eyelids, respectively fixed on the brow, infraorbital margin, nasal root, orbit Peripheral deep and periosteal. The average follow-up of 18 5 months (12 to 36 months). Results The tumor was significantly reduced in 7 to 43 (43%) patients within 6 to 12 months after treatment. In 1 to 2 years, 11 (68.8%) tumors were reduced. Of the 4 cases, small disciform marks remained on the tumor, 3 cases had no obvious shrinkage, and 3 cases had enucleation due to a slight increase. Local tumor control rate of 81 3%. In addition to the retina and its submucosal see flake bleeding, I no other serious complications. Good eye fixation, radiotherapy positioning accuracy. Conclusion X-knife stereotactic radiotherapy of choroidal melanoma has better effect, no serious complications and high local control rate. Stretching through the eyelid muscle fixed eye method is reliable