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患者,男性,41岁。主因大便带血一个月入院。查体:肝脏肿大,右肋下可触及3cm,表面不光滑,质中等,有压痛。胸膝位:肛周外观无异常,手指进入顺利,距肛缘约2cm,6～10点可触及一肿物约4cm×4cm×1cm,质韧,边界清,有压痛,可活动。肛镜检查,其肿物呈黑色,上方有一约1cm×0.5cm×0.5cm紫红色息肉状物突入肠腔。取活检报告:恶性黑色素瘤,肝脏B超:多发实质占位。诊断:肛管直肠恶性黑色素瘤肝转移。 治疗:行剖腹探查:明确小肠、大肠无病变,肝脏有数个散在大小不等结节、质硬。支持恶性黑色素瘤肝转移诊断,行门静脉插管皮下埋藏器置入以达到对肝转移癌起区域化疗作用。行乙状结肠袢氏造瘘术预防远端肿瘤性梗阻,再经肛门将原发灶局部切除。术后化疗两天,随访半年患者健在。
Patient, male, 41 years old. The main reason was bloody stools admitted to the hospital one month. Physical examination: The liver is swollen, and the right rib can reach 3cm. The surface is not smooth, medium in quality, and tender. Chest and knee position: No abnormality in the appearance of the perianal area, the finger entered smoothly, about 2cm from the anal margin, and 6 to 10 points can touch a mass about 4cm x 4cm x 1cm, quality and toughness, clear boundary, tenderness, and activity. For anal examination, the tumor was black, with an approximately 1cm x 0.5cm x 0.5cm purple polyp protruding into the intestine. Take a biopsy report: malignant melanoma, liver B-ultrasound: multiple substantive masses. Diagnosis: Malignant melanoma of anorectal liver metastasis. Treatment: Laparotomy: clear small intestine, large intestine without lesions, liver scattered in varying sizes nodules, hard. To support the diagnosis of hepatic metastasis of malignant melanoma, subcutaneous thrombectomy by portal vein catheterization is performed to achieve regional chemotherapy effect on hepatic metastases. The sigmoid colon fistulostomy was used to prevent distal tumor obstruction, and then the primary lesion was locally resected through the anus. Two days after chemotherapy, the patient was alive for six months.