肝转移性眼底恶性黑素瘤的治疗探讨(附5例剖腹探查经验)

Resection of liver metastases from ocular melanoma remains discussional: an experience with 5 cases

目的探讨肝脏转移性黑素瘤手术切除的指征和可行性。方法和结果回顾2005年1月至2010年12月期间在我院行剖腹探查的5例肝脏转移性恶性黑素瘤患者的临床资料,并结合文献进行分析。5例眼底恶性黑素瘤转移至肝脏的患者,均行激进性手术治疗,术中发现腹腔和肝脏多发转移1例(仅行剖腹探查、肝脏活检术),肝内多发病灶4例(均行姑息性肝脏转移病灶切除术)。3例患者同期行围术期肝动脉栓塞化疗治疗。5例患者的预后均不佳,术后的平均生存时间为9.6(3～26)个月。结论肝脏转移性眼底恶性黑素瘤无法早期发现,且手术指征不明,预后较差,仍是临床上的一项治疗难题。

Objective To investigate the indications and feasibility of resecting liver metastases from ocular melanoma. Methods and Results From Jan. 2005 to Dec. 2010, 5 patients with liver metastases from ocular melanoma were admitted to our hospital and received abdominal exploration. The clinicopathologic features and the surgical results of the 5 patients were retrospectively analyzed together with the latest literatures home and abroad. All the 5 patients received aggressive surgical managements, and simultaneous intra-arterial hepatic chemoembolization （TACE） was done in three cases. One patient received liver biopsies only after discovery of multiple visceral metastases the other 4 with multiple liver metastases underwent palliative liver resection. All the 5 patients had poor prognoses, with a median overall postoperative survival rate of 9.6 （3-26） months. Conclusion Liver metastases from ocular melanoma are impossible to detect in an early stage. With unclear surgical indications and poor prognosis, it remains hard to handle in clinical practice.