肛管直肠恶性黑色素瘤三例报告并文献复习

Three Patients with Anorectal Malignant Melanoma: A Case Report and Literature Review

目的探讨肛管直肠恶性黑色素瘤的临床特点,总结诊治经验。方法回顾分析我院1994年1月—2012年10月收治的3例肛管直肠恶性黑色素瘤临床资料,并复习相关文献。结果本组3例均有表浅部位黑色素瘤切除的病史,其中2例病理诊断为恶性黑色素瘤。在表浅黑色素瘤术后1～3年原手术部位黑色素瘤复发,2例出现便血,1例肛门处肿块,1例出现直肠梗阻和腹股沟淋巴结增大。1例误诊为外痔,2例经直肠镜活检病理诊断直肠肛管恶性黑色素瘤。确诊后均行经腹会阴联合切除术,随访2例,于术后3年内死亡。结论表浅部位的恶性黑色素瘤患者应警惕可能同时存在或继发直肠肛管黑色素瘤,完善肠镜等相关检查,并嘱患者定期复查,做到早诊断、早治疗,提高患者生存率。

Objective To explore clinical features of anorectal malignant melanoma and share in the experiences of diagnosis and treatment.Methods Clinical data of 3 patients with anorectal malignant melanoma during January 1994 and June 2012 were retrospectively analyzed,and relevant literature were also reviewed.Results The 3 patients had a history of melanoma resection of superficial parts,and 2 patients were diagnosed as having malignant melanoma by pathology.Melanoma recurrence occurred in the original surgical parts 1 ～ 3 years after the resection,2 patients had hematochezia,1 had anal tumour and 1 developed intestinal obstruction and swollen inguinal lymph nodes.One patient was misdiagnosed as having external hemorrhoids,and two patients were confirmed as having anorectal malignant melanoma by pathological rectal biopsy.All the 3 patients underwent abdomino-perineal resection after diagnosis.Two patients were followed up but died within three years.Conclusion Patients with superficial malignant melanoma may be accompanied by or evoke malignant anorectal melanoma.Relevant enteroscope examinations and periodic review may be helpful in early diagnosis and treatment,and improving survival rate.