肛管直肠恶性黑色素瘤的外科治疗  

Surgical therapy for anorectal malignant melanoma

作　　者：王墨飞[1] 高克明[2] 范莹[1] 于好[2] 李春雨[1] 

机构地区：[1]中国医科大学附属第四医院肛肠科, 沈阳110032 [2]中国医科大学附属第一医院肛肠科

出　　处：《中华普通外科杂志》2011年第5期388-390,共3页Chinese Journal of General Surgery

摘　　要：目的探讨肛管直肠恶性黑色素瘤的临床特征、诊断及治疗经验。方法总结中国医科大学附属第四医院及附属第一医院33例肛管直肠恶性黑色素瘤患者的临床资料。依据手术方式分组，应用Fisher确切概率法，Kaplan-Meier方法和Log-rank检验进行统计学分析。结果肛管直肠恶性黑色素瘤以女性多见，发病年龄22～77（54．5±7．6）岁。便血、肛门疼痛为最常见的临床表现。首次就诊误诊率为67％（22／33）。肿瘤平均直径（3．5±1．7）cm，31例（94％，31／33）的肿瘤距肛缘不足5cm。术后平均生存期（14．0±6．5）个月，1、3、5年总生存率分别为48％、22％、10％。腹会阴联合切除组与局部切除组术后局部复发率比较，差异有统计学意义（P=0．049），3年特异性生存率差异无统计学意义（x2=0．268，P=0．582）。结论肛管直肠恶性黑色素瘤极易误诊，扩大切除并不能有效延长患者的生存期。Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma （ARMM）. Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed. Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum （APR）, and 11 patients underwent local excision （LE）. Survival analysis was carried out. Fisher＇s exact test and Log-rank test was used to compare the effects of these two different surgical procedures. Results ARMM had a female predominance, the mean age was 22 -77 （54. 5 ± 7.6 ） years. The major clinical signs included hematoehezia, anus pain. The misdiagnosis rate was 67 % （22/33）. The average tumor size was （3.5± 1.7） cm. Thirty-one petients（94% ,31/33） had ARMM within 5 cm from anus margin. Mean survival time was （ 14. 0 ±6. 5 ） months. The overall 1 -, 3-, and 5-year survival rates were 48 %, 22%, and 10% ,respectively. Local recurrence after curative LE was higher than APR （LE,64% vs APR,21%, P = 0. 049 ） , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR（LE,28% vs APR,31% , X2 =0. 268,P =0. 582）. Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis. Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.

关 键 词：黑色素瘤 肛管 直肠肿瘤 胃肠出血 

分 类 号：R735.3[医药卫生—肿瘤]