直肠肛管恶性黑色素瘤诊治体会

目的探讨直肠肛管恶性黑色素瘤的临床特点及生存分析。方法回顾性分析22例直肠肛管恶性黑色素瘤患者的临床资料和生存率。结果本组22例，占同期收治结直肠癌的0.3%（22/7300），首发症状为便血（77.3%），误诊率68.2%，首诊转移率63.6%；腹会阴联合切除术16例，局部切除术4例；辅助化疗9例，辅助免疫治疗6例；辅助放疗1例。22例患者1、3、5年生存率分别为54.5%、13.6%、9.1%。中位生存时间12月（95%CI：7.48-16.52）。结论直肠肛管恶性黑色素瘤少见，易误诊，易转移，预后差。外科治疗是目前无转移直肠肛管恶性黑色素瘤的首选治疗方法。

Diagnosis and treatment of anorectal malignant melanoma

Objective To review the diagnosis and treatment of anorectal malignant melanoma （ARMM）. Methods Clinicopathological data,including clinical features,diagnosis,surgical modelities and prognosis of 22 patients with ARMM were analyzed retrospectively. Results Twenty-two ARMM cases were enrolled,which accounted for 0.3% of all admitted patients with colorectal cancer at the same period. The most common complaints were hematochezia （77. 3%）, and the misdiagnosis rate was 68.2%. The metastasis rate before diagnosis was 63.6%. Of 22 patients 16 underwent abdominoperineal resection, 4 underwent extensive local excision, 9 received adjuvant chemotherapy, 6 received adjuvant immunotherapy and 1 received radiotherapy. The 1-,3-,and 5-year survival rates of the 22 patients were 54.5% ,13.6% and 9.1% ,respectively. The median survival time was 12 months （95% CI： 7. 48-16. 52 months）. Conclusions ARMM is a rare disease with poor prognosis,and surgery may be considered as the first choice for patients without distant metastasis.