肛管直肠恶性黑色素瘤25例  

Anorectal malignant melanoma:Analysis of 25 cases

作　　者：邓昌林[1] 周淑蓉[1] 谢明[2] 邹文俊[1] 许辉[1] 

机构地区：[1]中国人民解放军第四二二医院普外科,广东省湛江市524005 [2]中国人民解放军第四二二医院病理科,广东省湛江市524005

出　　处：《世界华人消化杂志》2014年第18期2645-2649,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨肛管直肠恶性黑色素瘤的临床特点、诊断治疗方法与预后的关系.方法:选择2000-01/2010-08我院收治的肛管直肠恶性黑色素瘤25例的临床资料、诊疗方法及结果进行回顾性分析.结果:肛管直肠恶性黑色素瘤的临床表现无特异性,误诊率高,18例患者在外院被误诊为痔疮或息肉,误诊率达72%;病理检查及特异性免疫标记蛋白HMB45、S-100、Vimentin等有助于鉴别诊断;肿瘤患者1和3年生存率分别为52%和20%;肿瘤患者1年生存率和3年生存率与临床分期、肿瘤浸润深度相关(P<0.05),而与患者性别、年龄、肿瘤大小、手术方式和术后是否化疗均不相关.结论:手术切除仍是肛门直肠黑色素瘤治疗的第一选择,预后与治疗方式无关,肿瘤临床分期、浸润深度是影响预后的重要因素,提高生存率的关键是早期发现、早期治疗.AIM： To investigate the clinical features, diagnosis, treatment and prognosis of anorectal malignant melanoma（ARMM）. METHODS： Clinical records of 25 patients diagnosed with ARMM between January 2000 and August 2010 were reviewed, and the major clinical features, treatment modalities and outcomes were analyzed.RESULTS： ARMM was associated with a high misdiagnosis rate because of nonspecific symptoms, and of all the patients, 18（72%） were misdiagnosed with polyposis or haemorrhoids at other hospitals. Pathologic examination and specific immunohistochemical markers HMB45,S-100, and Vimentin were helpful in the dif-ferential diagnosis of ARMM. The 1- and 3-year survival rates were 52% and 20%, respectively. The survival was related to clinical stage and the depth of invasion（P〈0.05）, but not with sex, age, tumor size, operation mode or chemotherapy（P〉0.05）.CONCLUSION： The primary treatment for rectal ARMM is surgery, and the type of treatment is not correlated with survival. Clinical stage and the depth of invasion are the main factors affecting survival. Early diagnosis and treatment are crucial to improve the prognosis of these patients.

关 键 词：肛管直肠恶性黑色素瘤 预后因素 手术治疗 

分 类 号：R735.38[医药卫生—肿瘤]