22例肛管直肠恶性黑色素瘤临床分析

Retrospective Analysis of 22 Cases of Anorectal Malignant Melanoma

目的：分析肛管直肠恶性黑色素瘤（ anorectal malignant melanoma,AMM）的临床特点、肠镜表现、病理特点及诊治情况。方法分析四川大学华西医院2009年4月至2014年10月肛管直肠恶性黑色素瘤住院病例共22例。总结患者的病史、临床症状、肠镜表现、实验室检查及诊治情况,统计随访结果并复习文献。结果22例患者中男8例,女14例,男女比例为1：1.75,发病年龄53~79岁,平均发病年龄62.9岁。临床以便血为主诉多见,占86.3%（19/22）。肠镜下表现多样,多为单发或多发隆起物,表面溃烂,部分可有色素沉着。治疗无特效手段,手术切除是AMM目前首选的治疗手段,但对手术方式的选择尚存争议。结论肛管直肠恶性黑色素瘤侵袭性强,临床特点及肠镜表现缺乏特异性,诊治易被延误,早期可发生转移,5年生存率较低；确诊需病理组化。目前国内外尚无AMM的规范诊治指南,临床医师对此病的认识亟待提高。

Objective Analysis the clinical features,colonoscopy performance,pathological features and the diagnosis and treatment of Anorectal malignant melanoma（ AMM）. Methods Analysis 22 hospitalized cases of AMM from April 2009 to Octo-ber 2014 in West China Hospital of Sichuan University. Summary of the patient＇s medical history, clinical symptoms,colonoscopy, laboratory examination and treatment,the statistical follow-up results and review of the literature. Result In all 22 cases,14 fe-males,8 males,Male to female ratio was 1：1. 75,Age of onset 53-79 years old,The average Age of onset 62. 9 years old. The main complaint of an AMM patient is not specific. Most chief complaint is bleeding 86. 3%（19/22）. Under colonoscopy manifestation, can be single or multiple bumps,with surface ulceration,some may have pigmentation. No special effects of treatment methods,sur-gical resection is now the preferred treatment of AMM,but the choice of surgical approach is controversial. In Conclusion Ano-rectal malignant melanoma（ AMM） is a very rare and aggressive disease Clinical characteristics and the performance of the colonos-copy lack of specificity. Susceptible to delays in diagnosisand Early may occurs metastasis. 5-year survival rate is low. Diagnosis requires pathological staining results. Currently there is no standardized treatment guidelines of AMM. Clinician awareness of the disease needs to be improved.