CAJ | 학술논문

目的探讨肛管直肠恶性黑色素瘤的临床特征、诊断及治疗经验.方法总结中国医科大学附属第四医院及附属第一医院33例肛管直肠恶性黑色素瘤患者的临床资料.依据手术方式分组,应用Fisher确切概率法,Kaplan-Meier方法和Log-rank检验进行统计学分析.结果肛管直肠恶性黑色素瘤以女性多见,发病年龄22～77(54.5 ±7.6)岁.便血、肛门疼痛为最常见的临床表现.首次就诊误诊率为67%(22/33).肿瘤平均直径(3.5 ± 1.7) cm,31例(94%,31/33)的肿瘤距肛缘不足5 cm.术后平均生存期(14.0 ± 6.5)个月,1、3、5年总生存率分别为48%、22%、10%.腹会阴联合切除组与局部切除组术后局部复发率比较,差异有统计学意义(P=0.049),3年特异性生存率差异无统计学意义(x2=0.268,P=0.582).结论肛管直肠恶性黑色素瘤极易误诊,扩大切除并不能有效延长患者的生存期.
목적 탐토항관직장악성흑색소류적림상특정、진단급치료경험.방법 총결중국의과대학부속제사의원급부속제일의원33례항관직장악성흑색소류환자적림상자료.의거수술방식분조,응용Fisher학절개솔법,Kaplan-Meier방법화Log-rank검험진행통계학분석.결과 항관직장악성흑색소류이녀성다견,발병년령22～77(54.5 ±7.6)세.편혈、항문동통위최상견적림상표현.수차취진오진솔위67%(22/33).종류평균직경(3.5 ± 1.7) cm,31례(94%,31/33)적종류거항연불족5 cm.술후평균생존기(14.0 ± 6.5)개월,1、3、5년총생존솔분별위48%、22%、10%.복회음연합절제조여국부절제조술후국부복발솔비교,차이유통계학의의(P=0.049),3년특이성생존솔차이무통계학의의(x2=0.268,P=0.582).결론 항관직장악성흑색소류겁역오진,확대절제병불능유효연장환자적생존기.
Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma (ARMM).Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed.Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum (APR), and 11 patients underwent local excision (LE).Survival analysis was carried out.Fisher's exact test and Log-rank test was used to compare the effects of these two different surgical procedures.Results ARMM had a female predominance, the mean age was 22 -77(54.5 ± 7.6) years.The major clinical signs included hematochezia, anus pain.The misdiagnosis rate was 67% (22/33).The average tumor size was (3.5 ±1.7) cm.Thirty-one petients(94% ,31/33) had ARMM within 5 cm from anus margin.Mean survival time was (14.0 ± 6.5)months.The overall 1-,3-,and 5-year survival rates were 48% ,22% , and 10% , respectively.Local recurrence after curative LE was higher than APR (LE,64% vs APR, 21% , P = 0.049) , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR (LE, 28% vs APR ,31%, x2 = 0.268, P = 0.582).Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis.Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.