目的 分析儿童视网膜母细胞瘤(retinoblastoma, RB)个体化综合治疗的疗效和存在的问题。方法 依据患儿全身情况和临床分期,对59例(75只患眼)RB患儿采取个体化综合治疗,对其疗效和存在问题进行临床分析。结果 RB患儿常见的首发症状为白瞳症35例(60%),斜视12例(20%),结膜充血6例(10%),视力下降3例(5%),眼突3例(5%)。59例RB患儿眼内期3年生存率为90%(43/48),眼外期3年生存率为45%(5/11),总3年生存率为81%(48/59)。75只患眼总的保眼率为41.3%(31/75),其中A～C期的保眼率为100%,D期的保眼率为68%(17/25),E期的保眼率为13.8%(4/29);2例眼外期RB患儿因肿瘤巨大无法行手术治疗,9例眼外期手术成功切除肿瘤,手术切除率为82%。结论 RB 的个体化综合治疗可以提高患儿的3年生存率及保眼率,但E期患儿的眼球摘除率仍然很高,眼外期RB患儿的管理是今后工作中的重点和难点。

Objective To analyze the effect and existing problems of individualized comprehensive treatment of children’s retinoblastoma (RB). Methods Based on the general condition and clinical staging of 59 child patients (75 eyes) with RB, their curative effect and existing problems of individualized comprehensive treatment were analyzed. Results RB children’s initial symptoms were common: leukocoria in 35 cases (60%), strabismus in 12 cases (20%), conjunctival congestion in 6 cases (10%), decreased vision in 3 patients (5%), exophthalmus in 3 cases (5%). In 59 children with RB, their intraocular stage three-year survival rate was 90% (43/48), extraocular period survival rate was 45% (5/11), overall survival rate was 81% (48/59). Of the 75 affected eyes, the total preserved eye rate was 41.3% (31/75), including A - C stage preserved eye rate of 100%, D stage preserved eye rate of 68% (17/25), E stage preserved eye rate of 13.8% (4/29). Two extraocular RB patients because of large size of tumor could not do surgery, nine extraocular stage patients underwent successful surgical removal of the tumor, the surgical resection rate was 82%. Conclusions Individualized comprehensive treatment of RB can improve the survival rate of children and the recovery rate of eye, but the eye removal rate in E period children is still high. The management of child patients with extraocular period RB is important and difficult.