手术方式影响肛管直肠恶性黑色素瘤的预后

Different Surgical Procedures Affect the Prognosis of Anorectal Malignant Melanoma

目的:比较经腹直肠肛门切除术(AbdominoperinealResection,APR)与经肛门局部切除术(LocalExcision,LE)对肛管直肠恶性黑色素瘤(anorectalmalignantmelanoma,AMM)预后的影响。方法:回顾分析1994年至2004年我院经手术治疗的8例AMM患者和1994年至2004年12月CNKI全文数据库以个案报道并有随访资料的文献共44篇107例的临床资料。根据手术方式分组应用寿命表法和KaplanMeier方法(SPSS10.0forwindows)进行统计分析。结果:根治性手术治疗AMM的1、2、3、5年生存率分别为55.26%、37.76%、31.21%、20.34%,中位生存时间为21.24个月;其中LE术后的1、2、3、5年生存率分别为48.39%、27.60%、27.60%、9.20%,中位生存时间为11.75个月;APR手术后的1、2、3、5年生存率分别为62.26%、41.62%、32.87%、25.13%,中位生存时间25.01个月。KaplanMeier法比较APR术与LE术的生存率有显著差异(P<0.05)。结论:AMM患者的预后与外科手术方式有密切关系,APR手术预后好于LE手术,提示首次治疗手术方式选择较重要,应根据患者的综合因素来选择手术方式。

Objective：To compare the effects of abdominoperineal resection （APR） and local excision （LE） on the prognosis of anorectal malignant melanoma（AMM）. Methods：The data of 8 patients with AMM from 1994 to 2004 in our hospital and 107 cases reported by 44 authors from 1994 to 2004 in CNKI database were reviewed. 84 patients underwent APR, while 31 patients underwent LE. Survival analysis was performed and Kaplan-Meier was used to compare the effects of these two different surgical procedures （ SPSS10.0 for windows）. Results： The overall 1-, 2-, 3-, 5- year survival rates for AMM treated by radical surgery were 55.26 %, 37.76%, 31.21% and 20.34% respectively, the median survival time was 21.24 months. The overall 1-, 2-, 3-, 5- year survival rates for LE group were 48.39 %, 27.60 %, 27.60 % and 9. 20% respectively, the median survival time was 11.75 months. The overall 1-,2-, 3-, 5- year survival rates for APR group were 62.26%, 41.62%, 32.87% and 25.13% respectively, the median survival time was 25.01 months. Survival analysis found there were significant differences in survival rates between APR group and LE group （ P 〈0.05 ）. Conclusion：The prognosis of AMM is related to the surgical procedures. AMM treated by APR has a better survival than by LE. It indicates that surgical procedure is important and should be selected on the basis of the comprehensive factors of the patients with AMM.