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(2)瓒呭井绲�(ji茅)妲�(g貌u)锛氶浕閺′笅鑿婂舰鍦�(tu谩n)鐨勪腑蹇冭厰鍏�(n猫i)鍙鍒风媭绐佽捣锛岄叿浼艰绁炵稉(j墨ng)鑺辩媭椋�(fleuret)鐨勬墖鐙€绐佸嚭鐨勮秴寰祼(ji茅)妲�(g貌u)锛屾彁绀鸿缍�(w菐ng)鑶滄瘝绱�(x矛)鑳炵槫鑸囪绱�(x矛)鑳炲悓婧�銆�

(3)鍏嶇柅绲勭箶鍖栧(xu茅)锛氳叓鐦ょ窗(x矛)鑳炲彲琛ㄩ仈(d谩)NSE銆丼YN銆丆D56绛�锛屽叿鏈夎缍�(w菐ng)鑶滆鎰熺窗(x矛)鑳炲垎鍖栫殑鑵槫绱�(x矛)鑳為倓鍙〃閬�(d谩)瑕栫恫(w菐ng)鑶滅祼(ji茅)鍚堣泲鐧�銆侀寪楂旇铔嬬櫧銆佽缍�(w菐ng)鑶滆妗胯泲鐧�銆丮LGAPC绛夌壒鐣版€ф(bi膩o)瑷樼墿锛屾澶�锛孠i-67寰€寰€鍛堢従(xi脿n)楂樿〃閬�(d谩)銆�

(4)鍒嗗瓙妾㈡脯(c猫)锛歊B1鍩哄洜绐佽畩锛�1q銆�2p銆�6p鍜�13q鐛插緱锛�16q涓熷け锛孨MYC锛孧DMX锛孧DM²鍩哄洜鎿�(ku貌)澧炵瓑銆�

7.鍩哄洜妾㈡脯(c猫)锛氶伜鍌冲瀷Rb鎮ｈ€呬腑鍗�45%锛岀偤甯告煋鑹查珨椤€ч伜鍌�锛屽椤巼绱勭偤90%銆傛湁姊濅欢鐨勫湴鏂瑰缓璀板悓鏅�(sh铆)閫�(j矛n)琛屽鍛ㄨ鍜岃叓鐦や腑RB1鍩哄洜绐佽畩妾㈡脯(c猫)锛岀洰鍓嶉閬镐簩浠ｆ脯(c猫)搴�(澶栭’瀛愮祫鎴栧熀鍥犵祫娓�(c猫)搴�)銆傞毃钁楃獊璁婂垎鏋愭柟娉曞拰鎶€琛�(sh霉)鐨勯’钁楁敼鍠勶紝鐩墠妾㈠嚭鐜囧凡鎻愰珮鑷�90%浠ヤ笂銆�

(涓�)瑷烘柗妯�(bi膩o)婧�(zh菙n)

閫氬父锛岀劇(w煤)闇€鐥呯悊纰鸿獚(r猫n)鍗冲彲鑷ㄥ簥瑷烘柗鐪煎収(n猫i)瑕栫恫(w菐ng)鑶滄瘝绱�(x矛)鑳炵槫銆傚湪鍏ㄨ韩楹婚唹锛岄瀼鑶滃杩櫒涓嬬殑鏁ｇ灣鐪煎簳妾㈡煡鍙互妾㈡煡鍏ㄩ儴瑕栫恫(w菐ng)鑶�锛孊鍨嬭秴鑱叉尝妾㈡煡灏�(du矛)浜庤嚚搴婅ê鏂锋湁閲嶈鎰忕京锛孋T鍙鑵槫鍏�(n猫i)閳ｅ寲锛孧RI鍧囧彲椤ず鑵槫鐨勪綅缃�銆佸舰鐙€銆佸ぇ灏忓強鐪煎钄撳欢鎯呮硜銆�

绱�10%锝�15%鐨勬偅鑰呭彲浠ョ櫦(f膩)鐢熻叓鐦よ綁(zhu菐n)绉�锛屽叾鐪煎収(n猫i)甯稿嚭鐝�(xi脿n)鍏稿瀷绲勭箶瀛�(xu茅)鐗瑰緛锛屽渚靛叆娣辫剤绲�(lu貌)鑶滃拰闉忚啘鎴栬櫣鑶滃彈绱垨鐫媭楂斿彈绱垨瑕栫缍�(j墨ng)鍙楃疮瓒婇亷(gu貌)绡╂澘銆傞爤灏�(du矛)閫欓鎮ｈ€呰妾㈡煡鍜屽啀鍒嗙礆(j铆)锛屾鏌ユ墜娈靛寘鎷鎺冩弿銆侀楂撶┛鍒烘椿妾㈠強鑵扮┛銆�

(鍥�)閼掑垾瑷烘柗

1.杞�(zhu菐n)绉绘€х溂鍏�(n猫i)鐐庯細鎮ｅ厭閫氬父浜庨珮鐔卞悗鐧�(f膩)鐥�锛岀梾鍘熼珨缍�(j墨ng)琛€娑插惊鐠�(hu谩n)閫�(j矛n)鍏ョ溂鍏�(n猫i)銆傛偅鐪煎墠鎴�銆佺幓鐠冮珨鍏�(n猫i)澶ч噺婊插嚭锛屽墠鎴跨⿳鑶挎垨绌嶈锛屽彲琛ㄧ従(xi脿n)鐐虹櫧鐬崇櫏銆傜溂澹撲竴鑸綆浜庢甯搞€�

2.Coats?銆傚く棰婂彣閰佹銆戠殑琛岄儳鍡屽€岃緩鐟旂獫鍨╅劊缃狜绀鸿缍�(w菐ng)鑶滆绠＄暟甯告摯(ku貌)寮�锛屽父瑕嬪井琛€绠＄槫锛岃缍�(w菐ng)鑶滀笅澶ч噺榛冪櫧鑹叉徊鍑�锛屽彲鍛堢櫧鐬崇櫏銆傛鐪奸彙鐪煎簳妾㈡煡鐒�(w煤)瀵�(sh铆)鎬ч殕璧峰銆�

3.鏃╃敘(ch菐n)鍏掕缍�(w菐ng)鑶滅梾璁婏細鎮ｅ厭浣庨珨閲�锛屽叿鏈夋棭鐢�(ch菐n)鍙插拰楂樻績搴﹀惛姘у彶銆傞洐鐪间笉鍚岀▼搴︾殑澧炵敓鎬х梾璁�锛屽毚(y谩n)閲嶈€呭彲鐧�(f膩)鐢熺壗鎷夋€ц缍�(w菐ng)鑶滆劔闆�锛屽鐢熺梾璁婃敹绺嚦鏅剁媭楂斿悗锛屽彲鍛堢櫧鐬崇櫏琛ㄧ従(xi脿n)銆�

4.鍘熷鐜荤拑楂旀寔绾�(x霉)澧炵敓鐧ワ細?ji菐n)铦�?c猫)灏忕溂鐞冦€佺櫧鐬崇櫏锛孊瓒呭拰CT鐒�(w煤)鍗犱綅鐥呰畩銆�

5.澧炴畺鎬х幓鐠冮珨瑕栫恫(w菐ng)鑶滅梾璁�銆丯orrie鐥呮垨鐩搁棞(gu膩n)鐤�?銆傚摷@椤炵柧鐥呮湁鏅�(sh铆)琛ㄧ従(xi脿n)鑸囦笉鍏稿瀷Rb鐩镐技锛屼絾鐫媭绐佺壗寮�銆佸皬瑙掕啘銆佸悎骞跺叏韬暟甯�(濡傦細灏忛牠)绛夌壒寰佷箣涓€鎳�(y墨ng)鑰冩叜閼掑垾瑷烘柗銆侭瓒呫€丆T妾㈡煡浠ュ強鍏跺畠鐤剧梾鐩搁棞(gu膩n)鍩哄洜绐佽畩妾㈡脯(c猫)涔熸湁閼掑垾瑷烘柗鍍�(ji脿)鍊�銆�

鍥�銆佽叓鐦ゅ垎鏈�

RB鐨勫垎鏈熷皪(du矛)鍊�(g猫)楂斿寲娌荤檪鍙婇爯(y霉)鍚庡垽鏂锋湁閲嶈鎰忕京銆傚父鐢ㄥ垎鏈燂細鐪煎収(n猫i)鏈熻缍�(w菐ng)鑶滄瘝绱�(x矛)鑳炵槫鍦�(gu贸)闅涘垎鏈�(International IntraocularRetinoblastomaClassification锛孖IRC)锛岀敤浜庨爯(y霉)娓�(c猫)鍖栧(xu茅)娌荤檪鑱�(li谩n)鍚堝眬閮ㄦ不鐧傜殑鏁堟灉鍜岃⿻(p铆ng)浼扮柧鐥呴爯(y霉)鍚庛€�

2016骞寸編鍦�(gu贸)鐧岀櫏鑱�(li谩n)鍚堝鍝℃渻(hu矛)(AmericanJoint CommitteeonCancer,AJCC)鐧�(f膩)甯冧簡绗�8鐗圱NM鍒嗘湡锛屾彁鍑轰簡鑷ㄥ簥鍒嗘湡鍜岀梾鐞嗗垎鏈熴€傛渶鏂扮増TNM鍒嗘湡绲�(ji茅)鍚圛IRC灏�(du矛)鐪煎収(n猫i)鏈熻叓鐦ゅ師鐧�(f膩)鐥呯伓鍜屾挱鏁ｆ儏娉侀€�(j矛n)琛岀殑鍒嗛锛屽寘鎷叓鐦ょ殑鐪肩湺娴告饯(r霉n)銆佹穻宸寸祼(ji茅)杞�(zhu菐n)绉�銆佽绁炵稉(j墨ng)杞�(zhu菐n)绉诲拰琛€娑茶綁(zhu菐n)绉荤瓑鐪煎鏈熼€�(j矛n)灞曟儏娉�锛岄倓鏍规摎(j霉)鑵槫鐨勭櫦(f膩)鐥呯壒榛�(di菐n)鍜屽熀鍥犳娓�(c猫)绲�(ji茅)鏋�锛屽紩鍏鍒嗘湡锛屽嵆閬哄偝鐗规€у垎鏈�锛岀敤浠ヨ閷凴B1鍩哄洜鐨勯珨绱�(x矛)鑳炵獊璁婃儏娉佸拰Rb瀹舵棌鍙茬瓑鍥犵礌銆�

鏈(gu墨)鑼冭憲閲嶇溂鍏�(n猫i)鏈熸偅鑰呯殑瑷烘不锛岀洰鍓嶅湅(gu贸)鍏�(n猫i)閫氱敤鐨勭偤IIRC鍒嗘湡锛屾晠绻肩簩(x霉)鏍规摎(j霉)IIRC鍒嗘湡閫�(j矛n)琛屾柟妗堢殑閬告搰锛屾湁姊濅欢鐨勯啱(y墨)闄㈠彲鎳�(y墨ng)鐢ㄦ柊鐗圓JCC鍒嗘湡(琛�2)銆傜溂鍏�(n猫i)鏈熻缍�(w菐ng)鑶滄瘝绱�(x矛)鑳炵槫鍦�(gu贸)闅涘垎鏈�(International IntraocularRetinoblastomaClassification)锛�

1.GroupA锛氶仩(yu菐n)闆㈤粌鏂戜腑蹇冨嚬鍜岃鐩ょ殑灏忚缍�(w菐ng)鑶滃収(n猫i)鑵槫

•鎵€鏈夎叓鐦ょ殑鏈€闀�(zh菐ng)寰戝皬浜庣瓑浜�3mm锛岄檺鍒朵簬瑕栫恫(w菐ng)鑶滃収(n猫i)

•鎵€鏈夎叓鐦よ窛榛冩枒涓績鍑圭殑璺濋洟澶т簬绛変簬3mm锛岃窛瑕栫洡鐨勮窛闆㈠ぇ浜庣瓑浜�1.5mm銆�

2.GroupB锛氭墍鏈夐檺鍒朵簬瑕栫恫(w菐ng)鑶滃収(n猫i)鐨勬畼鐣欑殑瀛ょ珛鐨勮叓鐦�銆�

•闄愬埗浜庤缍�(w菐ng)鑶滃収(n猫i)鐨勯潪A绲勭殑鍏跺畠鑵槫;

•灏忎簬3mm鐨勮叓鐦や即闅ㄧ殑瑕栫恫(w菐ng)鑶滀笅绌嶆恫涓嶄即鏈夎缍�(w菐ng)鑶滀笅绋銆�

3.GroupC锛氫即鏈夊眬闄愮殑瑕栫恫(w菐ng)鑶滀笅娑叉垨鐜荤拑楂旂ó妞�銆�

•瀛ょ珛鐨勮叓鐦�;

•鏈夋垨鏃㈠線鏇炬湁瑕栫恫(w菐ng)鑶滀笅绌嶆恫锛岀ó妞嶅皬浜�1/4瑕栫恫(w菐ng)鑶�;

•灞€閮ㄥ井灏忕殑鏅剁媭楂旂ó妞嶅彲鎺ヨ繎瀛ょ珛鑵槫;

•渚�(l谩i)鑷叓鐦ょ殑灞€閮ㄨ缍�(w菐ng)鑶滀笅绋灏忎簬3mm(2DD)銆�

4.GroupD锛氳叓鐦や綅浜庣溂鍏�(n猫i)锛屼即鏈夊唬娉涚殑鐨勭幓鐠冮珨鍙婅缍�(w菐ng)鑶滀笅绋銆�

•宸ㄥぇ鎴栧綄婕殑鑵槫;

•鏈夋垨鏃㈠線鏇炬湁瑕栫恫(w菐ng)鑶滀笅绌嶆恫涓嶄即鏈夌ó妞�锛屽彲鑷村叏瑕栫恫(w菐ng)鑶滆劔闆�;

•褰屾极鎴栧法澶х幓鐠冮珨鍏�(n猫i)绋锛屽彲鍖呮嫭绱�(x矛)灏�“鑴傛ǎ”鐜荤拑楂斿収(n猫i)绋鎴栫劇(w煤)琛€绠＄殑宸ㄥぇ鐦ゅ;

•褰屾极鐨勮缍�(w菐ng)鑶滀笅绋鍙寘鎷祼(ji茅)绡€(ji茅)妯ｇ槫楂旂ó妞�銆�

5.GroupE锛氬瓨鍦ㄨ嚦灏�1鍊�(g猫)闋�(y霉)鍚庝笉鑹洜绱�銆�

•鑵槫瑙稿強瑙掕啘;

•鑵槫鍓嶇鑷虫櫠鐙€楂斿墠琛ㄩ潰鍙疮鍙婄潾鐙€楂旀垨鍓嶆;

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AB鏈熸偅鑰咃紝琛屽眬閮ㄦ不鐧�(婵€鍏夋垨鍐峰噸娌荤檪);

C鏈�銆丏鏈熸偅鑰呰鍖栧(xu茅)娌荤檪鑱�(li谩n)鍚堝眬閮ㄦ不鐧�锛屽啀鐢ㄥ眬閮ㄦ不鐧傛帶娈樼暀鐥呯伓;

E鏈熺劇(w煤)鑷ㄥ簥楂樺嵄鍥犵礌鎮ｈ€呮槸淇濈溂閭勬槸鎽樼溂锛岃嚚搴�

浠嶇劧瀛樺湪鐖�(zh膿ng)璀�锛屽湪瀵嗗垏瑙€瀵熸不鐧傚弽鎳�(y墨ng)鐨勫墠鎻愪笅锛屽彲浠ュ厛閲囩敤鍖栧(xu茅)娌荤檪鑱�(li谩n)鍚堝眬閮ㄦ不鐧備繚鐪�锛屼竴鏃︾櫦(f膩)鐝�(xi脿n)娌荤檪鏁堟灉涓嶄匠锛岀洝蹇憳闄ょ溂鐞�;E鏈熶即鏈夎嚚搴婇珮鍗卞洜绱犳偅鑰咃紝琛岀溂鐞冩憳闄よ(sh霉)銆�

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4.褰卞儚瀛�(xu茅)妾㈡煡锛氳兏閮╔绶氭鍋�(c猫)浣嶇墖;鑵归儴B瓒�锛岃瀵熸湁鐒�(w煤)鑵ぇ鐨勬穻宸寸祼(ji茅)鍙婂叾浠栫梾鐏�;闋”鑸囩溂閮∕RI骞虫巸+澧炲挤(qi谩ng)锛屾鏌ヨ叇瀵�(sh铆)璩�(zh矛)銆佺溂鐪跺懆鍦嶇祫绻斿強瑕栫缍�(j墨ng)鏈夌劇(w煤)娴告饯(r霉n)銆�

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1.灞€閮ㄦ不鐧傦細

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瑭叉妧琛�(sh霉)鍍呴檺浜庡熀搴曚笉澶т簬4.5mm銆佸帤搴︿笉澶т簬2.5mm鐨勮叓鐦�銆傛縺鍏夊彲鐩存帴闃绘柗鑵槫鐨勮渚�銆傛澶栵紝閭勫父浣跨敤鍐峰噸鐧傛硶娌荤檪璧ら亾鍙婂叾闄勮繎澶у皬涓嶈秴閬�(gu貌)3.5mm銆佸帤搴︿笉澶т簬2mm鐨勮叓鐦�銆備竴鑸儏娉佷笅锛岄€ｇ簩(x霉)娌荤檪1锝�2鍊�(g猫)鏈�锛屾瘡鏈堟垨姣�?j墨)钃氣偓(g猫)鏈堝(sh铆)鏂戒竴娆′笁鍊�(g猫)寰挵(hu谩n)鐨勫喎鍑嶆不鐧傚嵆鍙嵅寰楄純濂界殑鑵槫鎺у埗鐜�銆�

缍�(j墨ng)鐬冲瓟婧�?z茅)宀戠吋銊掑僵涓旂幆N閲嶈鐨勫眬閮ㄧ檪娉�锛岃┎鏂规硶閫氶亷(gu貌)浜屾サ绠℃縺鍏夊櫒灏囩啽閲忛泦涓湪娆″厜鍑濇按骞炽€傚眬閮ㄧ檪娉曡垏鍖栫檪鏂规硶鍙浉浜掑崝(xi茅)鍚�銆傞€欑ó缍滃悎娌荤檪鐨勫眬閮ㄦ帶鍒剁巼鍙仈(d谩)70%锝�80%銆傚眬閮ㄧ檪娉曠殑骞剁櫦(f膩)鐧ュ寘鎷竴閬�(gu貌)鎬ф伎娑叉€ц缍�(w菐ng)鑶滆劔闆�銆佽缍�(w菐ng)鑶滅壗鎷夊強灞€閮ㄧ簴缍寲绛夈€�

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鍖栫檪鐢ㄤ簬娌荤檪鐪煎収(n猫i)鍙婄溂澶朢b锛屽叾绲﹁棩鍙互鏄郴绲�(t菕ng)鎬х殑銆佺祼(ji茅)鑶滀笅銆佸嫊(d貌ng)鑴堝収(n猫i)鎴栫幓鐠冮珨鍏�(n猫i)銆傚叏韬寲鐧傛不鐧俁b鍙互閬垮厤鏀剧檪骞剁櫦(f膩)鐧ュ強鍏舵墍鑷寸殑绗簩鑵槫鐨勭櫦(f膩)鐢�銆�

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鈶犲寲瀛�(xu茅)娓涘:鍖栧(xu茅)娓涘涔熷彨杓斿姪鍖栫檪锛岀溂鍏�(n猫i)鏈烺b閲囩敤鍖栧(xu茅)娓涘娌荤檪鐨勭洰鐨勬槸绺皬鑵槫浠ヤ究浜庢噳(y墨ng)鐢ㄥ眬閮ㄦ不鐧�銆傚儏10%鐨勬偅鑰呭柈鐢ㄥ寲瀛�(xu茅)娓涘娌荤檪鏈夋晥锛�90%鐨勬偅鑰呬粛闇€鑱�(li谩n)鍚堝眬閮ㄦ不鐧�銆傚柈闆欑溂鎮ｈ€呭潎鍙互浣跨敤鍖栧(xu茅)娓涘娌荤檪銆�

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b.浠讳綍绋嬪害鐨勮剤绲�(lu貌)鑶滃拰瑕栫缍�(j墨ng)鍙楃疮;

c.绡╂澘鍚庤绁炵稉(j墨ng)鍙楃疮(鏂风闄版€�);

d.闉忚啘鍙楃疮(鏈┛閫�);

e.鍠崹(d煤)鍓嶇瘈(ji茅)鍙楃疮(鐫媭楂斿拰/鎴栬櫣鑶滀镜瑗�)銆�

閫欓儴鍒嗘偅鑰呬粛鎳�(y墨ng)绲︿簣VEC鏂规娌荤檪銆傝€屼笉浼存湁鐥呯悊楂樺嵄鍥犵礌鐨勬偅鑰�锛屼笉寤鸿鍖栫檪銆傚寘鎷細a.鍠崹(d煤)灞€闄愭€ц剤绲�(lu貌)鑶滀镜鐘細鑵槫鐥呯伓鐩村緫(鍘氬害鎴�?q奴)鎸�?灏忎簬3mm涓旀湭鍒伴仈(d谩)闉忚啘;b.鍠崹(d煤)绡╂澘鍓嶈绁炵稉(j墨ng)渚电姱;c.灞€闄愭€ц剤绲�(lu貌)鑶滀镜鐘拰绡╂澘鍓嶈绁炵稉(j墨ng)渚电姱銆�

(2)鍕�(d貌ng)鑴堝収(n猫i)鐏屾敞鍖栫檪娌荤檪

鏍规摎(j霉)鑵槫鎵€鍦ㄨВ鍓栦綅缃紝鍒╃敤鏁�(sh霉)瀛楁笡褰辫绠￠€犲奖姗�(j墨)(digitalsubtractionangiography,DSA)鎶€琛�(sh霉)锛岀稉(j墨ng)鐨┛鍒鸿偂鍕�(d貌ng)鑴�锛岄€氶亷(gu貌)DSA椤儚锛屽皫(d菐o)寮曞皫(d菐o)绠￠€�(j矛n)鍏ラ牳鍏�(n猫i)鍕�(d貌ng)鑴�锛屼娇寰皫(d菐o)绠￠牠绔綅浜庣溂鍕�(d貌ng)鑴堥枊鍙ｈ檿銆傛敞灏勭編娉曚緰(Melphalan):4锝�6鍊�(g猫)鏈�2.5mg;6锝�12鍊�(g猫)鏈�3.0mg;1锝�3姝�4.0mg;>3姝�5.0mg銆�

鏈夋槑椤殑鍓綔鐢ㄦ檪(sh铆)闄嶄綆鍔戦噺鐨�25%锛岀暥(d膩ng)鍙嶆噳(y墨ng)涓嶈冻鏅�(sh铆)澧炲姞鍔戦噺鐨�25%銆傛渶澶у姂閲忎笉鑳借秴閬�(gu貌)0.5mg/kg/鐧傜▼;鐢ㄧ敓鐞嗛菇姘�50ml绋€閲嬪悗绶╂參鐏屾敞銆傞噰鐢ㄨ几娑叉车鎸佺簩(x霉)娉典汉锛屾车鍏ユ檪(sh铆)闁�30锝�45min銆傛帓闄ょ溂鍕�(d貌ng)鑴堝強闋稿収(n猫i)鍕�(d貌ng)鑴堣鏍撳舰鎴愬悗绲�(ji茅)鏉熸墜琛�(sh霉)銆傝(sh霉)鍚庡姞澹撳寘鎵庣┛鍒洪儴浣�6h銆�1娆″寲鐧傚悗1鍊�(g猫)鏈堝京(f霉)鏌ュ寲鐧傛晥鏋滐紝鏍规摎(j霉)妾㈡煡绲�(ji茅)鏋滄焙瀹氭槸鍚︾辜绾�(x霉)瓒呴伕浠嬪叆鍕�(d貌ng)鑴堝収(n猫i)鐏屾敞鍖栫檪娌荤檪銆�

閲嶅京(f霉)閫�(j矛n)琛屽嫊(d貌ng)鑴堝寲鐧�2锝�6娆℃不鐧傦紝闁撻殧3锝�4鍛�銆傝嚚搴婅瓑瀵�(sh铆)鐧傛晥椤憲鐨勮棩鐗╀富瑕佹湁锛氶Μ娉曡槶銆佸崱閴�銆佹嫇?f霉)娑┑??锛熺瓫槎�?j霉)鍏烽珨鎯呮硜閬告搰1锝�3绋棩鐗╀娇鐢ㄣ€傞Μ娉曡槶锛�≤0.5mg/kg锛屼竴鑸柈鐪间娇鐢�5mg;鍗￠墤锛�20-60mg;鎷�?f霉)娑┑鎷�?.5-1.0mg銆�

(3)鐜荤拑楂斿収(n猫i)鍖栫檪

鐐轰簡鏇村ソ鍦版帶鍒剁幓鐠冮珨鑵斿収(n猫i)绋鐨勮缍�(w菐ng)鑶滄瘝绱�(x矛)鑳炵槫鎮ｈ€呯梾鎯�锛屾噳(y墨ng)鍦ㄧ幓鐠冮珨鑵斿収(n猫i)娉ㄥ皠缇庢硶渚栥€傚湪楹婚唹涓�锛岄€氶亷(gu貌)寰炲墠鎴挎娊鍙栧皯閲忔恫楂旀垨閫氶亷(gu貌)鎸夋懇渚�(l谩i)闄嶄綆鐪煎銆傚皣缇庢硶渚�(鎴栬垏鎷�?f霉)娑┑鍒癕鍚�)閫氶亷(gu貌)绲�(ji茅)鑶�锛岄瀼鑶滃拰鐫媭楂旀墎骞抽儴鐢ㄥ皬閲濋牠娉ㄥ皠鍒版櫠鐙€楂斿悗闈㈢殑鐜荤拑楂斾腑銆�

娉ㄥ皠鍚庢嫈閲濇檪(sh铆)锛屽皣娉ㄥ皠閮ㄤ綅瀵嗗皝骞剁敤鍐峰噸鐧傛硶婊呰弻锛岃紩杓曟悥鍕�(d貌ng)鐪肩潧浠ュ皣钘ョ墿鍒嗗竷鍦ㄦ暣鍊�(g猫)鐜荤拑楂斿収(n猫i)銆傝秴鑱茬敓鐗╅’寰彙鐢ㄤ簬瑭�(p铆ng)浼拌櫣鑶滃悗闅辫棌浜庣潾鐙€楂斿崁(q奴)鍩熺殑鑵槫锛屼互纰鸿獚(r猫n)娉ㄥ皠閮ㄤ綅鐒�(w煤)鑵槫瀛樺湪銆備絾鏄幓鐠冮珨鑵斿収(n猫i)鍖栫檪钘ョ墿娉ㄥ皠瀛樺湪鐪煎収(n猫i)姣掓€с€傝嚚搴婇啱(y墨)鐢熼倓鎳�(y墨ng)瑭叉剰璀�(sh铆)鍒板弽寰�(f霉)鐜荤拑楂斿収(n猫i)娉ㄥ皠锛屾渻(hu矛)澧炲姞鑵槫绱�(x矛)鑳炵溂澶栨摯(ku貌)鏁ｇ殑棰�(f膿ng)闅�(xi菐n)銆�

3.鏀惧皠娌荤檪

澶栨斁灏勬妧琛�(sh霉)閬╃敤浜庢暣鍊�(g猫)鐪肩悆鍙楃疮鐨勬偅鑰呭強淇濈暀鐪肩悆鎴栨不鐧傜溂鐪跺銆佷腑妯炵缍�(j墨ng)绯荤当(t菕ng)鍙婂叾浠栭儴浣嶈綁(zhu菐n)绉绘€х梾璁娿€傝缍�(w菐ng)鑶滄瘝绱�(x矛)鑳炵槫鏄珮搴︽斁灏勬晱鎰熺殑鑵槫锛屽眬閮ㄦ斁鐧傛晥鏋滃ソ銆傜洰鍓嶅父鐢ㄤ笁缍仼褰㈠拰瑾�(di脿o)寮�(qi谩ng)鏀剧檪鎶€琛�(sh霉)锛屽姂閲忥細35锝�45Gy锛屼緷鎿�(j霉)鑵槫澶у皬姹哄畾銆�

鍒嗘鏀剧檪锛屽柈娆″姂閲忎笉瓒呴亷(gu貌)180cGy銆傜洰鍓嶅父鐢ㄧ洿绶氬姞閫熷櫒X绶氭垨闆诲瓙绶氭不鐧�銆傛噳(y墨ng)鐢ㄦ斁鐧傝兘娓涘皯姝ｅ父绲勭箶鐨勭収灏勫姂閲�锛屾笡灏戦仩(yu菐n)鏈熷壇浣滅敤鍜岀浜岃叓鐦ょ櫦(f膩)鐢熼ⅷ(f膿ng)闅�(xi菐n)銆傛斁灏勬不鐧傜殑鎳�(y墨ng)鐢ㄩ亷(gu貌)绋嬩腑锛屾噳(y墨ng)娉ㄦ剰鏈€澶х▼搴︽笡灏戞偅鑰呯殑绱⿳鏀惧皠鍔戦噺锛岄伩鍏嶆不鐧傚苟鐧�(f膩)鐧�锛屽閬茬櫦(f膩)姝ｅ父绲勭箶鎼嶅偡鍜岀浜岃叓鐦�銆傚嵆浣夸笉浣跨敤鏀惧皠娌荤檪锛岃┎鎮ｈ€呯兢楂旂殑绗簩鑵槫鐧�(f膩)鐥呯巼涔熷崄鍒嗛珮銆�

4.鐪肩悆鎽橀櫎琛�(sh霉)

鐪肩悆鎽橀櫎琛�(sh霉)鐨勬寚寰佺偤鑵槫杓冨ぇ锛屽厖婊挎暣鍊�(g猫)鐜荤拑楂�;鎴栬叓鐦や镜鍙婂墠鎴挎垨鑰呭嚭鐝�(xi脿n)鏂扮敓琛€绠℃€ч潚鍏夌溂锛岃鍔涗繚瀛樼殑鍙兘鎬фサ灏�锛屽奖鍍忎笂鑵槫鍙枒鍚戣绁炵稉(j墨ng)钄撳欢锛屼絾鑼冨湇灏氬湪鐞冨悗瑕栫缍�(j墨ng)杩戠鐨勬偅鐪�銆傛鎵嬭(sh霉)鎳�(y墨ng)鐢辩稉(j墨ng)椹�(y脿n)璞愬瘜鐨勭溂绉戦啱(y墨)鐢熷(sh铆)鏂�;鐪肩悆闋堝畬濂界劇(w煤)鎼嶅彇鍑猴紝閬垮厤鐪肩悆绌垮瓟锛岀⒑淇濈溂鐪朵笉鐧�(f膩)鐢熸儭鎬ц叓鐦ょó妞�銆傜偤浜嗘洿濂藉垎鏈�锛屾憳闄ょ溂鐞冩檪(sh铆)鎳�(y墨ng)鍚屾檪(sh铆)鍓櫎涓€娈佃绁炵稉(j墨ng)(10锝�15mm)銆傝(sh霉)鍚庢牴鎿�(j霉)鐥呯悊閬告搰鏄惁閫�(j矛n)琛岄爯(y霉)闃叉€у寲鐧�銆傚皪(du矛)浜庡瓨鍦ㄧ湺鍏�(n猫i)杞�(zhu菐n)绉荤殑鎮ｅ厭锛屾噳(y墨ng)鍚堢悊閬告搰鍖栫檪銆佹墜琛�(sh霉)(鎽橀櫎琛�(sh霉))鍜屾斁灏勬不鐧備互閬�(d谩)鍒版帶鍒惰叓鐦�銆�

鍏€佸苟鐧�(f膩)鐧ュ強杓斿姪娌荤檪

(涓€)鑲濊嚐姣掓€�

姣忓€�(g猫)鐧傜▼鍓嶄竴鑸渶瑕佹鏌ヨ倽鍔熻兘浠ョ⒑瀹氭槸鍚﹀彲浠ユ寜鏅�(sh铆)鍖栫檪銆�

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2.鑶界磪绱犲崌楂橈細姣忎竴鍊�(g猫)鐧傜▼鍓嶇殑鐩存帴鑶界磪绱�≥24µmol/L鑰�(姝ｅ父鍊�1.5鍊�)鍙互寤堕伈鍖栫檪浣跨敤VCR銆傜洿鎺ヨ喗绱呯礌灏忎簬24µmol/L鏅�(sh铆)锛孷CR鎳�(y墨ng)浜�50%鍔戦噺锛岀洿鎺ヨ喗绱呯礌鎭㈠京(f霉)鍒�<24µmol/L鍚庢噳(y墨ng)鎭㈠京(f霉)鍏ㄥ姂閲忋€�

(浜�)绁炵稉(j墨ng)姣掓€�

闀�(zh菐ng)鏄ユ柊鍫垮姂閲忎笉寰楄秴閬�(gu貌)2mg銆傚父瑕嬬殑杓曞害姣掓€ф湁涓嬮牅鐤肩棝銆佷究绉�銆佹繁鍙嶅皠娓涘急銆傛湁鏅�(sh铆)鍙互鏈夌櫦(f膩)鑱查殰绀欙紝鎳�(y墨ng)鍜屽康鐝犵悆鑿屾€у枆鐐庣浉閼掑垾銆傚鏋滄湁鎸佺簩(x霉)瀛樺湪鐨勮吂绲炵棝銆佹鎱�(t脿i)涓嶇┅(w臎n)銆佸毚(y谩n)閲嶇殑鐤肩棝鎴栨姉鍒╁翱婵€绱犲翱婵€绱犲垎娉岀暟甯�(SIADH)绛夋槑椤殑涓瘨琛ㄧ従(xi脿n)鑰呮噳(y墨ng)鏆仠浣跨敤?锛涜?f霉)鑷�1绱�(j铆)姣掓€�锛屽彲浜�50%鍔戦噺銆�

(涓�)鑰虫瘨鎬�

甯歌(gu墨)鍔戦噺鐨勫崱閴戝皪(du矛)鑱藉姏褰遍熆杓冨皬锛屼絾楂樺姂閲忕殑鍗￠墤鍓囧悓妯ｅ彲浠ュ皫(d菐o)鑷磋純楂樼殑鑱藉姏鎼嶅偡鐜�銆傝€虫瘨鎬х壒榛�(di菐n)鐐洪珮闋婚儴鍒�(4-8kHz)鑱藉姏涓嬮檷銆傛瘡鐧傜▼鍓嶉€�(j矛n)琛屾偅鑰呯暩璁婄敘(ch菐n)鐗╄€宠伈鐧�(f膩)灏勬娓�(c猫)锛屽ぇ浜�2000Hz锛岃伣鍔涗笅闄嶅皬浜�20dB锛屼笅鐧傜▼鍗￠墤娓涢噺50%;澶т簬20dB锛屽仠鐢ㄥ崱閴�銆�

(鍥�)涓€х矑绱�(x矛)鑳炵己涔忎即鐧�(f膩)鐔�

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(浜�)寰�(f霉)鏂圭：鑳虹敳鍣佸攽(SMZco)闋�(y霉)闃插崱姘忚偤鍥婅煵鎰熸煋

寤鸿闀�(zh菐ng)鏈熸湇鐢⊿MZco闋�(y霉)闃插崱姘忚偤鍥婅煵鎰熸煋锛�25mg/kg/澶�锛屽垎鍏╂锛屾渶澶у姂閲忔瘡娆�0.5锛屾瘡鏃ュ叐娆�锛屾瘡鍛�3澶╋紝鐩磋嚦鍖栫檪绲�(ji茅)鏉熷悗3鍊�(g猫)鏈�銆�

(鍏�)琛€娑叉瘨鎬�

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2.琛€灏忔澘娓涘皯锛氳灏忔澘瑷�(j矛)鏁�(sh霉)<20×10⁹/L鏅�(sh铆)锛屾噳(y墨ng)杓告敞琛€灏忔澘锛屼即鏈夋槑椤嚭琛€鐧ョ媭鎴栨劅鏌撹〃鐝�(xi脿n)鏅�(sh铆)杓告敞鎸囧緛鍙仼鐣�(d膩ng)鏀惧銆�

3.涓€х矑绱�(x矛)鑳炵己涔忥細灏�(du矛)闋�(y霉)鏈熸渻(hu矛)鍑虹従(xi脿n)杓冮暦(zh菐ng)鏅�(sh铆)闁撶矑绱�(x矛)鑳炵己涔忚€呭彲浠ヤ娇鐢ㄧ矑绱�(x矛)鑳為泦钀藉埡婵€鍥犲瓙3锝�5µg/(kg•娆�)锛岀毊涓嬫敞灏�銆�

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