Bilik R, Kahanovich S, Rubin M, Rothem A, Gelernter I, Kaplan I
Department of Plastic Surgery, Beilinson Medical Center, Petah Tikva, Israel.
Surg Gynecol Obstet. 1987 Oct;165(4):333-8.
A retrospective study was carried out on 219 patients who underwent surgical treatment of a malignant melanoma. A scalpel was used in 96 patients in group 1 and CO2 laser beam was used in 123 patients in group 2. The average length of hospitalization for group 2 was longer (16.3 versus 12.8 days for group 1). This was due to failure of the skin graft; 32.5 per cent in group 2 versus 15.6 per cent in group 1 (p = 0.005). The accumulative rate of recurrence for both groups was almost the same although there were significant differences according to the various parameters. Male patients in group 2 had a significantly higher rate of recurrence as compared with female patients in the same group (p less than 0.001) and male patients in group 1 (p = 0.002). In both groups, there was a significantly higher rate of recurrence for ulcerated primary lesions and those lesions more than 1.6 millimeters thick (p = 0.05). Patients in group 2, with lesions more than 3 millimeters in thickness, had a higher rate of recurrence than those in group 1 (54.6 versus 40.6 per cent). In both groups, patients who underwent elective regional dissection of lymph nodes had a lower rate of recurrence (19.4 per cent) than those patients who did not undergo dissection (53.6 per cent) (p = 0.001). It is suggested that thermal damage to the blood and lymph vessels incurred during laser excision may be more extensive than has been reported. These damaged walls may cause the higher rate of distal metastases of malignant melanoma from a primary lesion more than 1.6 millimeters in thickness; primarily in male patients.
对219例接受恶性黑色素瘤手术治疗的患者进行了一项回顾性研究。第1组96例患者使用手术刀，第2组123例患者使用二氧化碳激光束。第2组的平均住院时间更长（第1组为12.8天，第2组为16.3天）。这是由于植皮失败；第2组为32.5%，第1组为15.6%（p = 0.005）。尽管根据各种参数存在显著差异，但两组的累积复发率几乎相同。第2组男性患者的复发率明显高于同组女性患者（p小于0.001）和第1组男性患者（p = 0.002）。在两组中，溃疡型原发性病变和厚度超过1.6毫米的病变复发率明显更高（p = 0.05）。第2组中厚度超过3毫米的病变患者的复发率高于第1组（分别为54.6%和40.6%）。在两组中，接受选择性区域淋巴结清扫的患者的复发率（19.4%）低于未接受清扫的患者（53.6%）（p = 0.001）。有人提出，激光切除过程中对血液和淋巴管造成的热损伤可能比报道的更广泛。这些受损的血管壁可能导致厚度超过1.6毫米的原发性病变的恶性黑色素瘤远端转移率更高；主要发生在男性患者中。
