鼻腔鼻窦恶性黑色素瘤22例诊疗分析  

Diagnosis and treatment of sinonasal malignant melanoma in 22 cases

作　　者：郑明奋[1] 黄健男[1] 刘华盛[1] 肖平[1] 张沈华[1] 傅向军[1] 

机构地区：[1]广东省第二人民医院耳鼻咽喉头颈外科,广东广州510317

出　　处：《中国耳鼻咽喉颅底外科杂志》2015年第1期24-26,30,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的探讨鼻腔鼻窦恶性黑色素瘤（malignant melanoma,MM）的诊断与治疗,进一步提高治愈率。方法回顾性分析总结22例鼻腔鼻窦恶性黑色素瘤的诊治情况;符合（2010年AJCC分期）Ⅲ期15例;Ⅳ期7例。本组全部患者行原发灶扩大切除术,5例患者行全颈淋巴清扫;9例患者行上颈部淋巴清扫。术后免疫治疗22例,放疗18例,化疗14例。结果全组患者原发灶肉眼全切,病理报告均为恶性黑色素瘤。随访1~5年死亡20例,分别为1年生存者20例（20/22,90%）;3年生存者7例（7/22,32%）;5年生存者2例（2/22,9%）。死亡原因为局部复发和远处转移。结论目前鼻腔鼻窦恶性黑色素瘤的治疗效果不佳,以手术为主的综合治疗为首选,颈淋巴清扫应尽早施行,早期发现,早期诊断,广泛彻底的手术切除可望提高本病的生存率。Objective To study the clinical diagnosis and treatment of sinonasal malignant melanoma for promoting the survival rate.Methods Clinical data of 22 cases suffering from sinonasal malignant melanoma were analyzed retrospectively.According to staging criterion of AJCC 2010,15 cases were at stage Ⅲ,7 cases at stage Ⅳ.Extended resection of primary tumor was performed in all the 22 cases.Radical neck lymph node dissection was applied to 5 cases,and upper neck region lymph node dissection to 9.All patients received immunotherapy.Postoperative radiotherapy and chemotherapy were given to 18 cases and 14 cases respectively.Results Gross excision of primary tumor was obtained in all cases.Diagnosis of malignant melanoma was confirmed with postoperative pathology.During postoperative follow up for1 to 5 years,20 patients died.The survival rates of one-year,three-year and five-year were 90%（ 20 /22）,32%（ 7 /22）,and 9%（ 2 /22） respectively.The most common causes of death were recurrence and metastasis.Conclusion The prognosis of sinonasal malignant melanoma is poor.The preferred treatment strategy is surgical comprehensive therapy.Neck lymph node dissection is necessary.Early diagnosis and extensive excision of primary tumor may improve the survival of patients.

关 键 词：恶性黑色素瘤 鼻腔鼻窦 诊断 治疗 

分 类 号：R739.62[医药卫生—肿瘤]