CAJ | 학술논문

目的回顾性分析手术扩大切除联合小剂量干扰素(IFN)α2b治疗皮肤恶性黑素瘤的疗效.方法 32例皮肤恶性黑素瘤患者经术前检查分期后(Ⅱ期21例、Ⅲ期11例)接受了手术扩大切除,手术范围距离皮损或组织病理取材后瘢痕边界1～2cm.手术方法包括:直接切除缝合4例、截指(趾)6例、皮肤游离移植15例、任意皮瓣转移3例和轴型皮瓣转移4例.有区域淋巴结转移行选择性淋巴结摘除者9例,腹股沟淋巴结清扫者2例.术后1周,给予IFN-α2b 300万IU皮下注射每周3次,连续1～3年.结果所有患者的切口均甲级愈合.截止到2011年6月,2例患者失访,其余30例患者中,6例随访5年,生存4例,死亡2例(均为ⅢC期)；7例随访3～5年,生存5例,死亡2例(均为ⅢC期)；13例随访1～3年,生存12例,死亡1例(为ⅢB期)；4例随访1年内的无1例死亡.现存的25例患者中,8例合并区域淋巴结转移,其中2例为手术后2年内新出现的区域淋巴结转移；8例完成了IFN-α2b治疗3年的疗程,11例已接受了1年以上的治疗,不良反应轻微.结论手术扩大切除联合小剂量干扰素α2b治疗Ⅱ期和Ⅲ期皮肤恶性黑素瘤,能降低局部复发,患者生存率高.
목적 회고성분석수술확대절제연합소제량간우소(IFN)α2b치료피부악성흑소류적료효.방법 32례피부악성흑소류환자경술전검사분기후(Ⅱ기21례、Ⅲ기11례)접수료수술확대절제,수술범위거리피손혹조직병리취재후반흔변계1～2cm.수술방법포괄:직접절제봉합4례、절지(지)6례、피부유리이식15례、임의피판전이3례화축형피판전이4례.유구역림파결전이행선택성림파결적제자9례,복고구림파결청소자2례.술후1주,급여IFN-α2b 300만IU피하주사매주3차,련속1～3년.결과 소유환자적절구균갑급유합.절지도2011년6월,2례환자실방,기여30례환자중,6례수방5년,생존4례,사망2례(균위ⅢC기)；7례수방3～5년,생존5례,사망2례(균위ⅢC기)；13례수방1～3년,생존12례,사망1례(위ⅢB기)；4례수방1년내적무1례사망.현존적25례환자중,8례합병구역림파결전이,기중2례위수술후2년내신출현적구역림파결전이；8례완성료IFN-α2b치료3년적료정,11례이접수료1년이상적치료,불량반응경미.결론 수술확대절제연합소제량간우소α2b치료Ⅱ기화Ⅲ기피부악성흑소류,능강저국부복발,환자생존솔고.
Objective To retrospectively analyze the therapeutic effect of wide surgical excision combined with low-dose adjuvant interferon-alpha 2b on cutaneous malignant melanoma.Methods A total of 32 patients with cutaneous malignant melanoma received wide surgical excision after preoperative examination and staging.The excisions were performed with a margin measuring 1-2 cm from the visible lesions or biopsy scars.Surgical modalities included direct suture after excision(4 patients),dactylolysis or toe amputation(6 patients),free skin grafting(15 patients),random skin flap transfer(3 patients)and pedicle skin flap transfer(4 patients).Lymph nodes were selectively dissected in 9 patients with regional transfer of lymph nodes,and inguinal lymph nodes were cleared away in 2 patients.One week after the operation,patients received adjuvant therapy with subcutaneous injection of interferon-alpha 2b(3 million IU,thrice per week)for one to three years.Results Preoperative tumor staging revealed 21 cases of cutaneous malignant melanoma at stage Ⅱ,and 11 cases at stage Ⅲ.The excisions healed by the first stage in all the patients.Up to June 2011,2 patients had been lost to follow up,5 patients with stage Ⅲ melanoma had died.Survival was observed in all of the 4 patients receiving 1-year follow up,12 of 13 patients receiving 1-3 year follow up,5 of 7 patients receiving 3-5 year follow up,and 4 of 6 receiving 5-year follow up.Of the 25 surviving patients,regional lymph node metastasis was observed in 8 patients,which developed within 2 years after the operation in 2 patients.The adjuvant therapy with interferon-alpha 2b lasted 3 years in 8 patients,and more than 1 year in 11 patients.Side effects were mild.Conclusion Wide surgical excision plus low-dose interferon-alpha 2b is effective for the treatment of stage Ⅱ and Ⅲ cutaneous malignant melanoma with lower local recurrence and higher survival rate.