原发性肛管直肠恶性黑色素瘤29例诊治体会

目的了解肛管直肠恶性黑色素瘤的生物学特性和根治性外科手术在治疗该病中的临床意义。方法回顾性总结自１９６５年至１９９５年在我院接受治疗的肛管直肠恶性黑色素瘤患者２９例的临床和病理资料。结果本组女１９例，男１０例，平均年龄５０岁。２９例患者中，接受了根治性手术（Ｍｉｌｅｓ手术）２３例。术后复发１７例，复发率为７４％（１７／２３），主要复发部位为远处转移。以性别，癌灶体积，色素产生，浸润深度和淋巴结转移为变量分析与预后的关系，仅淋巴结转移与术后复发的关系非常密切（Ｐ＜００５）。其余６例接受姑息性手术治疗。全组病例术后总５年生存率为２９％。根治性手术病例术后５年生存和无病生存率分别为３７％和２８％。未切除的６例全部死亡。中位生存期为１３５个月。结论肛管恶性直肠黑色素瘤是一种恶性程度极高的肿瘤。即使施行根治性外科手术治疗预后亦不佳。术中见到有淋巴结转移者预后更差。

Primary malignant melanoma of the anorectum

Objective This study was designed to investigate the biological characteristics of anorectal melanoma and the significance of radical operation for its treatment. MethodBZA retrospective analysis was made of the clinical and pathological features as well as the results of surgical treatment of 29 cases with anorectal melanoma collected from 1965 to 1995 in Cancer Hospital of Chinese Academy of Medical Sciences. Results There were 19 females and 10 males with their mean age of 50 years.Twentythree out of the 29 cases underwent curative resection (Miles' operation), recurrences developed in 17 (74%) cases with major recurrence pattern of distant metastasis. Only lymph node metastasis influenced the relapse of these patients when analyzing variables such as gender, tumor size, melanin, invasive depth and lymph node spread in terms of prognosis. The remaining six patients were submitted to palliative surgery.The overall postoperative five year's survival rate of all patients and of that received curative resection were 29% and 37% respectively. Six unresectable patients died of their disease at a median of 135 months. HZ Conclusion anorectal melanoma is an aggressive malignant tumor with poor prognosis even though radical resection was done. It was even worse when lymph nodes were involved at the time of operation.