口腔颌面部原发性恶性黑色素瘤治疗的回顾分析

目的：探索影响口腔颌面部原发性恶性黑色素瘤的预后因素,以期获得最佳的治疗模式。方法：回顾分析1970-2004我院收治的54例口腔恶黑的临床资料。结果：依照AJCC分类标准,Ⅰ期2例、Ⅱ期3例、Ⅲ期35例、Ⅳ期14例,本组Ⅲ、Ⅳ期5年生存率分别为34.3%、0,Ⅲ、Ⅳ期明显低于Ⅰ、Ⅱ期的生存率,经统计学处理有显著差异（P〈0.01）。冷冻活检者23例,有复发转移13例,3、5年生存率为43.5%35.5%、常规活检者31例,有复发转移26例,3、5年生存率为30.4%25.8%。原发灶手术治疗组与原发灶综合治疗组3、5年生存率两组经统计学处理有显著的差异（P〈0.01〉。共50例颈淋巴清扫术后淋巴结阳性检出率70.0%（35/50）。54例3年生存率38.9%、5年生存率27.8%、3例存活10年以上。结论：冷冻活检是术前正确的诊断方法,利于减少复发提高生存率,颈淋巴清扫是必要。原发灶冷冻、手术扩大切除病灶、颈淋巴清扫术、术后免疫治疗和放化疗的综合序列治疗能明显提高恶黑患者的生存率。

Retrospective Analysis of Primary Malignant Melanoma Located Oral Maxillofacial Region

Objective： To discuss the prognosis factors on the treatment of primary oral maxillofacial alignant melanoma.Methods： We collected and analysed 54 cases of malignant melanoma in our hospital from 1970to2004.Results： According to the AJCC standard,2cases with malignant melanoma were in stageⅠ,3cases in stageⅡ,35cases in stage Ⅲand 14cases in stage Ⅳ.Five year survival rates were 34.3% and 0 respectively in stage Ⅲ and stage IV,which were significantly lower than stage I and stage Ⅱ（P〈0.01）.The total three year survival rate was 38.5% and five year survival rate was 27.8%. 3 of them were survived more than 10 years. The positive cervical lymph node metastatic rate was 70% （ 35/ 50）. In 23 cases who were performed cryosurgery biopsy, recurrent and metastatic rate was 56%, three year survival rate was 43.5% and five year survival rate was35.5%. In 31 cases who were performed regular biops, recurrent and metastatic rate was 84%. Three year survival rate was 30.4% and five year survival rate was 25.8%. There were statistical differences in three year survival rate and five year survival rate between resection treatment group and comprehensive treatment group. Conclusion. Cryosurgery biopsy was a correct method for pathological diagnosis. The combined methods of extensive resection and cryosurgery of original site of melanoma were necessary Radical neck lymph nodes dissection plus immunochemotherapy were the effective therapy of oral maxillofacial malignant melanoma.