9例食管恶性黑色素瘤的临床分析

目的探讨食管恶性黑色素瘤的临床特征、诊断、治疗以及预后。方法回顾我院9例外科手术切除的食管黑色素瘤的相关临床资料,并对所有患者进行回访。结果患者9例,男8例,女1例,平均年龄（59.7±7.42）岁;肿瘤位于食管中段2例,食管下段7例;术前胃镜病理误报为其他类型食管癌5例;1例行食管切除,食管、胃吻合术联合皮肤黑色素瘤切除术,其余行食管切除,食管、胃食管吻合术;术后行辅助放化疗5例;患者术后平均生存期为（7±2.34）月,从明确肿瘤转移到死亡的平均时间为2.42个月。结论原发性食管恶性黑色素瘤临床罕见,预后较食管鳞癌差;食管黑色素瘤无特异性临床症状及影像学征象;术前胃镜下病理误报率高;手术治疗能有效缓解患者症状,但没有足够证据证明其在延长生存期方面较内科保守治疗有效。

Malignant melanoma in esophagus:A clinical analysis of 9 cases

Objective To study the clinical features,diagnosis and prognosis of malignant melanoma in esophagus.Methods Clinical data about 9 patients with surgically-removed malignant melanoma in esophagus were retrospectively analyzed.The patients were followed up.Results The mean age of the 9 patients（8 males and 1 female） was（59.7±7.42） years.The tumor was located in the middle and lower esophagus of 2 and 7 patients,respectively.The tumor was misdiagnosed as other esophageal cancers in 5 patients by gastroscopy.Of the 9 patients,1 underwent esophagectomy,the remaining 8 patients underwent combined esophagectomy and esophagogastrostomy.Five of them received adjuvant chemotherapy and radiotherapy after operation.The mean survival time of the patients was（7±2.34） months after operation.The average time from the definite diagnosis of tumor metastasis to the death of patients was 2.42 months.Conclusion Primary malignant melanoma of esophagus is a rare tumor with no specific clinical symptoms and imaging signs.Its clinical prognosis is poorer than that of squamous cell esophageal carcinoma and its endoscopic misdiagnosis rate is high.Surgical treatment can effectively relieve its clinical symptoms.However,no sufficient evidence can prove that surgery treatment is better than conservative medical treatment in prolonging the survival time of patients with malignant melanoma accompanying DM.