皮肤恶性黑色素瘤手术结合大剂量罗扰素治疗的疗效分析

THERAPEUTIC RESULT OF OPERATION COMBINED WITH LARGE-DOSE OF ROFERON-A FOR CUTANEOUS MALIGNANT MELANOMA

目的探讨皮肤恶性黑色素瘤手术结合大剂量罗扰素治疗的疗效。方法1998年1月～2005年12月，收治皮肤恶性黑色素瘤患者33例，男20例，女13例；年龄17～79岁。病程2个月～7年，中位病程3．5年。9例Ⅰ期患者行单纯病灶扩大切除结合中厚植皮（或邻位皮瓣）修复创面，23例Ⅱ期患者行病灶扩大切除及区域淋巴结清扫术（或截肢），1例Ⅲ期患者姑息性病灶切除。所有患者术后均辅以大剂量罗扰素生物治疗。结果9例Ⅰ期患者术后切口愈合好，获随访7个月～8年，无复发。Ⅱ期患者中，2例切口愈合延迟，经换药愈合；1例失访，余22例获随访5个月～7年，其中1例复发，部位于大腿原发灶旁，再次予病灶广泛切除后，大剂量罗扰素治疗。1例Ⅲ期患者治疗1年6个月后因肺部转移并发呼吸衰竭死亡。结论手术结合术后大剂量罗扰素综合治疗恶性黑色素瘤疗效满意。

Objective To observe the effects of operation with large-dose of Roferon-A for cutaneous malignant melanoma. Methods From January 1998 to December 2005, thirty-three patients with cutaneous malignant melanoma were treated. There were 20 males and 13 females, aging 17-79 years. The disease course was 2 months to 7 years. In 33 patients, nine patients identified as clinical-stage 1 received singly enlarged-resection to the primary lesion and performed split-thickness skin graft dermoplasty or adjacent skin flap repair; twenty-three patients identified as clinical-stage Ⅱ received enlarged-resection to the primary lesion and performed proximal lymphaden scavenge as well as received split-thickness skin graft dermoplasty ; and one patient identified as clinical-stage Ⅲ received palliative resection to the primary lesion. All patients received large dose of Roferon-A after operation. Results There are no recidivation in the 9 patients of clinical-stage Ⅰ . There are 1 recidivation and 1 quit in all the 23 patients of clinical-stage Ⅱ . One patient of clinical-stage Ⅲ died after 18 months of operation. Conclusion The operation combined with large-dose of Roferon-A after operation was a more effective way to treat cutaneous malignant melanoma.