肛管直肠恶性黑色素瘤28例治疗分析

Anorectal malignant melanoma:treatment and prognosis

目的 探讨肛管直肠恶性黑色素瘤 (AMM)合理的治疗方法。方法 回顾性分析我院于 1980～ 1998年确诊治疗的AMM病人 2 8例的临床病理情况、治疗方法及随访结果。生存分析用Kaplan Meier方法 ,生存分布比较用Log rank检验。结果 本组生存期较短 ,5年生存率 7% (2 / 2 8)。经腹直肠肛门切除术 (Miles手术 )与经肛门局部切除术 (LE)比较 ,尽管差异无显著意义 ,但生存期较长的 3例都为Miles术。辅助瘤苗 (BCG)治疗 ,效果较好。淋巴结无转移者生存期较长 ,男女生存期比较差异无显著意义。结论 AMM病人应首先考虑Miles术 ,特别是病灶局限 ,无远处淋巴结及脏器转移的病人 ,并应采用辅助免疫治疗 ,其效果更佳。

Objective[WT5”BZ] To evaluate operative procedures and perioperative comprehensive adjuvant therapy for anorectal malignant melanoma (AMM).[WT5”HZ] Methods[WT5”BZ] From 1980 to 1998,28 AMM patients were admitted.Clinical data, pathology, treatment and follow up were retrospectively analyzed. Survival analysis were graphically displayed using the Kaplan Meier method, and distributions were compared using the log rank test.[WT5”HZ] Results[WT5”BZ] Survival for the entire group was poor with 7% (2/28) at 5 years. Survival distribution of patients who underwent Miles procedure was more favorable than that of patients with local resection, although this was not statistically significant. However, three long term survivors were with Miles. Adjuvant immunotherapy with Bacillus Calmette Guerin (BCG) seemed to be useful. [WT5”HZ] Conclusions[WT5”BZ] Miles procedure should be considered in patients with localized anorectal melanoma, particularly those with smaller tumors and no evidence of nodal metastases. Adjuvant immunotherapy should be taken. [WT5”HZ]