Slingluff C L, Seigler H F
Department of Surgery, Duke University Medical Center, Durham, NC.
Ann Plast Surg. 1992 Jan;28(1):85-8. doi: 10.1097/00000637-199201000-00022.
Twenty-four patients with primary anorectal melanoma diagnosed since 1974 have been retrospectively studied. The most common presenting symptom was rectal bleeding, typically misdiagnosed as hemorrhoids. Progressive disease most commonly presented as a large pelvic mass, diffuse bilateral pulmonary nodules, or diffuse liver metastases. Twenty-one patients (88%) died of their disease; none survived more than 6 years. Among the patients who have died of their disease, mean survival was 2.2 years. Among assessable stage I patients initially managed with abdominoperineal resection (APR), 50% developed recurrent local regional disease (mean disease-free interval = 23 months), compared with 100% of those managed with more limited surgery (mean disease-free interval = 16 months). Even after APR, however, distant metastases were common, and there was no prolongation of survival for patients treated with APR. Primary melanoma of the anorectum has a high metastatic potential and carries a grave prognosis. APR appears to have some effect in controlling local and regional disease, but prolongation of survival will depend both on earlier diagnosis and on development of more successful therapeutic approaches.
对1974年以来确诊的24例原发性肛管直肠黑色素瘤患者进行了回顾性研究。最常见的首发症状是直肠出血，通常被误诊为痔疮。疾病进展最常见的表现为盆腔巨大肿块、双侧弥漫性肺结节或弥漫性肝转移。21例（88%）患者死于该疾病；无一例存活超过6年。在死于该疾病的患者中，平均生存期为2.2年。在最初接受腹会阴联合切除术（APR）治疗的可评估I期患者中，50%出现局部区域复发（平均无病间期=23个月），而接受更有限手术治疗的患者这一比例为100%（平均无病间期=16个月）。然而，即使在接受APR治疗后，远处转移也很常见，接受APR治疗的患者生存期并未延长。肛管直肠原发性黑色素瘤具有较高的转移潜能，预后严重。APR似乎对控制局部和区域疾病有一定作用，但生存期的延长将取决于早期诊断以及更成功治疗方法的开发。
