【摘要】 目的探讨肛管直肠恶性黑色素瘤(AMM)误诊对其预后的影响。方法回顾分析1994~2004年经我院手术治疗的8例AMM患者和1994~2004年12月CNKI全文数据库以个案报道并有随访资料的文献共48篇136例的临床资料,根据误诊疾病应用生命表法和Kaplan-Meier方法(SPSS10.0forwindows)进行统计分析。结果AMM的1年、2年、3年、5年和10年生存率分别为47.25%、34.17%、27.28%、17.78%、8.89%,中位生存时间为16.78月;有误诊患者的1年、2年、3年和5年生存率分别为58.41%、22.62%、22.62%、11.31%,中位生存时间为14.85月;无误诊患者的1年、2年、3年和5年生存率分别为50.19%、38.87%、29.02%、21.28%,中位生存时间为18.34月,但Kaplan-Meier法比较发现,误诊对AMM的生存影响无统计学差异(P>0.05)。但误诊的疾病类型对预后有显著影响(P=0.0072),误诊为痔的预后极差,其1年生存率只有28.89%,中位生存时间只有5.79月。结论有误诊患者的预后较差,但未显示统计学差异;误诊为痔将严重影响预后。更多还原

【Abstract】 Objective To study the effects of misdiagnosis on the prognosis of anorectal malignant melanoma (AMM).Methods 8 cases with AMM from 1994 to 2004 in our hospital and 136 cases reported by 48 papers from 1994 to 2004 in CNKI database were reviewed.84 patients underwent APR while 31 patients underwent LE.Survival analysis was performed and Kaplan-Meier was used to compare the effects of misdiagnosis on survival (SPSS 10.0 for windows).Results The overall 1-,2-,3-,5-,10-year survival rates for AMM were 47.25%,34.17%,27.28%,17.78% and 8.89% respectively,the median survival time was 16.78 months.The overall 1-,2-,3-,5-year survival rates for misdiagnosis group were 58.41%,22.62%,22.62% and 11.31% respectively,the median survival time was 14.85 months.The overall 1-,2-,3-,5-year survival rates for non-misdiagnosis group were 50.19%,38.87%,29.02% and 21.28% respectively,the median survival time was 18.34 months.Survival analysis found no significant difference between misdiagnosis group and no-misdiagnosis group (P>0.05).However,diseases variety of misdiagnosis were found different prognosis remarkably (P=0.007 2),especially AMM misdiagnosed as hemorrhoid,with the one year survival rates 28.89% and the median survival time 5.79 months only.Conclusion A bad prognosis of AMM is found related to misdiagnosis,but there are no statistical difference;however,AMM misdiagnosed as hemorrhoid will effect survival obviously.更多还原