肛管直肠黑色素瘤10例临床分析并文献复习  

Clinical analysis and review of 10 cases of anorectal malignant melanoma

作　　者：施波 邰清亮 陈国梁 侍新宇 姚慧慧 陈俊杰[1] 沈成龙[2] 周国强[2] 顾闻[1] 刘峰 何宋兵[1] Bo Shi;Qingliang Tai;Guoliang Chen;Xinyu Shi;Huihui Yao;Junjie Chen;Chenglong Shen;Guoqiang Zhou;Wen Gu;Feng Liu;Songbing He(Department of General Surgery,First Affiliated Hospital of Soochow University,Suzhou 215000,China;Department of Gastrointestinal Surgery,Changshu No.2 Hospital,Suzhou 215000,China;Department of General Surgery,Suzhou Yongding Hospital,Suzhou 215028,China)

机构地区：[1]苏州大学附属第一医院普外科,215000 [2]常熟市第二人民医院胃肠外科,215000 [3]苏州永鼎医院普外科,215028

出　　处：《中华结直肠疾病电子杂志》2024年第1期78-82,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：江苏省自然科学基金(No.BK20191172);苏州市医工结合协同创新研究项目(No.SLJ2021007);苏州市姑苏卫生重点人才项目(No.GSWS2020005)。

摘　　要：目的探讨肛管直肠恶性黑色素瘤(ARMM)的临床病理特征及诊治方法。方法回顾性分析苏州大学附属第一医院2011~2021年间收治的ARMM10例并结合文献复习,对其临床资料、病理特点、治疗结果和预后情况进行探讨并总结诊治经验。结果10例ARMM患者中,男性4例,女性6例;年龄50~79岁,平均发病年龄(61.4±7.6)岁。患者临床表现多样,但以便血为主,缺乏特异性,所有患者术前行CEA,CA19-9定量检测结果均正常;10例患者中,9例行免疫组化染色,其中主要指标有S-100、HBM、MelanA、Ki-67,9例患者S-100均为阳性;HBM8例阳性;MelanA除4例未查外,4例阳性,1例阴性。9例患者Ki-67均为阳性,其中5例阳性区>50%。6例接受腹会阴联合肿瘤切除术(Miles术),4例接受经肛门直肠肿物切除术;5例术后接受综合治疗,1例术后因泌尿系转移行尿道切除术,4例术后未行辅助治疗。患者总体生存期5.5个月~108个月,平均生存(30.6±29.5)个月,中位生存期28.0个月。结论ARMM是一种临床上罕见且恶性程度极高的恶性肿瘤,临床表现不典型,主要通过病理活检来确诊,对于确诊患者行腹会阴联合切除是主要的手术方式,术后可以辅助放化疗和免疫治疗。Objective To investigate the clinicopathological features,diagnosis and treatment of anorectal malignant melanoma(ARMM).Methods From 2011 to 2021,ten cases of ARMM confirmed by pathological examination were analyzed retrospectively.Combined with relevant literature,we discussed the clinical data,pathological features,treatment results,prognosis and summarized the experience of diagnosis and treatment.Results Among the 10 patients with ARMM,four were males and 6 were females,with the age ranged from 50 to 79 years old,and the average age of(61.4±7.6)years.The clinical manifestations are diverse and non-specific,but mainly bloody stools.The results of CEA,CA19-9 quantitative detection were normal in all patients before operation.Immunohistochemistry was performed in 9 cases,we mainly tested S-100,HBM,MelanA,Ki-67.S-100 was positive in 9 cases,HBM was positive in 8 cases,MelanA was positive in 4 cases and negative in one case except 4 cases.Ki-67 was positive in 9 cases,of which 5 cases had a positive area>50%.The 6 cases were submitted to abdominoperineal resection,and 4 cases were submitted to local resection of anorectal tumor.The 5 cases received multimodality therapy after operation,one case was submitted to urethrotomy because of urinary metastasis after operation,and 4 cases did not receive any therapy.The overall survival time of patients in this group was 5.5~108 months,the average time was(30.6±29.5)months,the median survival time was 28 months.Conclusion ARMM is a rare and highly malignant tumor with atypical clinical manifestations,which is mainly diagnosed by pathological biopsy,but digital anorectal examination plays an important role in the early detection of ARMM.Abdominoperineal resection is the main surgical method for confirmed patients.Radiotherapy,chemotherapy and immunotherapy can be supplemented.

关 键 词：肛管 直肠 黑色素瘤 临床病理特点 治疗 

分 类 号：R735.34[医药卫生—肿瘤]