直肠肛管恶性黑色素瘤的外科治疗及预后

目的探讨直肠肛管恶性黑色素瘤的外科治疗及局部复发、预后的影响因素。方法回顾性分析50例直肠肛管恶性黑色素瘤患者的临床病理资料,并对预后进行单因素及多因素分析。结果本组47例患者行肿瘤切除术,其中31例行腹会阴联合根治术,16例行肿瘤局部切除术;术后局部复发率分别为16.1%（5/31）和68.8%（11/16）。χ^2检验显示,手术方式与局部复发相关（P=0.001）。47例患者5年生存率18.2%,单因素分析显示,病灶单发（P=0.0458）和肿瘤侵犯深度（P=0.0053）与预后相关。多因素分析显示,肿瘤侵犯深度（P=0.010）是影响预后最主要因素。结论直肠肛管恶性黑色素瘤预后差,影响预后最主要的因素是肿瘤侵犯深度,腹会阴联合根治术后复发率低。

Analysis of recurrence and prognosis after surgical resection for anorectal melanoma

OBJECTIVE: To investigate the clinicopathologic factors related with recurrence and prognosis after surgical resection for anorectal melanoma. METHODS: The clinicopathologic factors related to recurrence and prognosis of 50 patients with anorectal melanoma after surgical resection were retrospectively analyzed using univariate and multivariate methods. RESULTS: Forty-seven patients underwent radical operation, including 31 abdominoperineal resection (APR) and 16 sphincter preserving operation. The local recurrence rates were 16.1%(5/31) and 68.8%(11/16) respectively. chi(2) analysis revealed that operation pattern was associated with local recurrence rate. The 5-year survival rate was 18.2%. Univariate analysis revealed that single tumor, intramural infiltration and operation pattern were related with prognosis. Multivariate analysis revealed that intramural infiltration was the most important prognostic factor for anorectal melanoma. CONCLUSIONS: The prognosis of anorectal melanoma is poor. Early diagnosis and treatment are important for the improving of curative effect.