作者：曾韬

单位：广东省惠东县人民医院病理科，广东 惠州 516300

Authors:  ZENG Tao

Unit:  Department of Pathology, Huidong People's Hospital, Huidong 516300, Guangdong, China

摘要：

目的  分析肛管直肠恶性黑色素瘤的临床特点和诊治疗效,提高临床诊治水平。方法  回顾性分析2010年1月至2019年4月30日检索CNKI、万方、维普数据库上肛管直肠恶性黑色素瘤的文献,筛选符合文献质量评价标准的文章,提取相关数据进行统计分析。结果  共纳入32篇文献,共36例患者纳入分析。本组患者平均年龄60.4±12.3岁,女性26例(72.2%),男性10例(27.8%)。26例患者(72.2%)以大便带血或便血为首发症状,12例(33.3%)患者出现误诊,7例(19.4%)误诊为痔。肿瘤长径0.5～8.0 cm,平均大小为(3.2±1.6)cm。12例(33.3%)患者淋巴结转移,8例(22.2%)远处转移,其中3例(8.3%)同时存在肝肺转移、5例(13.9%)肝转移。肿瘤大体病理形态息肉型6例(16.7%),结节型15例(41.7%),溃疡型15例(41.7%)。病理类型以上皮样、梭形、多形性为主。免疫组化Vimentin、HMB45、S100、Melan-A、Ki-67阳性率分别为93.8%、90.0%、96.2%、93.3%、93.8%。本组患者总体生存时间1～54个月,中位生存时间为6个月,1年生存率57.0%,3年生存率28.5%。结论  肛管直肠黑色素瘤预后差,手术治疗是此类患者的治疗基础。

关键词： 肛管直肠; 恶性黑色素瘤; 治疗; 预后

Abstract：

Objective  The aim of this study was to analyze the clinical characteristics, diagnosis and treatment of anorectal malignant melanoma (ARMM) and to improve the level of clinical diagnosis and treatment. Methods  A retrospective analysis was made on the literatures of anorectal malignant melanoma on CNKI, WanFang and Cqvip databases from January 2010 to April 30, 2019. The literatures that met the evaluation criteria for literature quality were screened and the relevant data were extracted for statistical analysis. Results  A total of 32 articles and 36 cases were included in the analysis. The mean age of patients was 60.4±12.3 year’s old, including 26 females (72.2%) and 10 males (27.8%). The first symptom of 26 patients (72.2%) was bloody stool or hematochezia. 12 patients (33.3%) were misdiagnosed and 7 patients (19.4%) were misdiagnosed as hemorrhoids. The diameter of tumor was 0.5~8.0 cm, with an average size of (3.2±1.6) cm. Peripheral lymph node metastasis was found in 12 patients (33.3%) and distant metastasis was found in 8 patients (22.2%). Among patients with distant metastasis, 3 patients (8.3%) had liver and lung metastasis and liver metastasis was found in 5 patients (13.9%). There were 6 cases of polyp type (16.7%), 15 cases of nodule type (41.7%) and 15 cases of ulcer type (41.7%). The pathological types were mainly dermoid, fusiform and pleomorphism. The positive rates of Vimentin, HMB45, S100, Melan-a and ki-67 were 93.8%, 90.0%, 96.2%, 93.3% and 93.8%, respectively. The overall survival time of patients in this group was 1~54 months, the median survival time was 6 months, the 1-year survival rate was 57.0%, and the 3-year survival rate was 28.5%. Conclusion  The prognosis of ARMM is poor. Radical surgery is the basis of treatment for patients with ARMM.

Key Words:  Anal canal and rectum; Malignant melanoma; Treatment; Prognosis