Pellet B, Saegesser F, Ozzello L, Vulliet F
Schweiz Med Wochenschr. 1975 May 3;105(18):587-90.
81 patients with tumors of the anal canal and anal margin treated at the Cantonal Hospital, Lausanne, during the period January 1942 to June 1974 have been studied. The morbid anatomy of transitional zone and cloacogenic carcinomas, subdivided into basaloid types, is related to the anatomy and histology of the normal anal canal. The average age of the patients was 66.5 years. The incidence of canal tumors was highest in women (71% of cases), but tumors of the anal margin were most frequent in men (75% of cases). The main symptom of anal canal growths in this series of advanced cases was blood on the feces; marginal tumours were associated with anal aching. Cloacogenic carcinomas of the basaloid type have the best prognosis; this is also related to the volume and invasion rate of the tumor, which are features difficult to assess. Melanomas have the worst prognosis; leiomyomas may grow like sarcomas despite their benign histological appearance. 18 patients had inguinal metastases, and only 2 of these are alive 2 1/2 and 3 1/2 years after excision of the rectum; the volume and histological type of the tumor were unrelated to the poor rate of survival. In the light of this experience, rectal amputation is the most effective prodecure for all canal tumors and for most tumors of the margin. Radiotherapy by itself is associated with an unacceptably high risk of actinic proctitis.
对1942年1月至1974年6月期间在洛桑州立医院接受治疗的81例肛管和肛缘肿瘤患者进行了研究。移行区癌和泄殖腔源癌（细分为基底样型）的病理解剖与正常肛管的解剖和组织学相关。患者的平均年龄为66.5岁。肛管肿瘤的发病率在女性中最高（占病例的71%），但肛缘肿瘤在男性中最为常见（占病例的75%）。在这一系列晚期病例中，肛管肿物的主要症状是便血；边缘肿瘤伴有肛门疼痛。基底样型泄殖腔源癌的预后最佳；这也与肿瘤的大小和浸润率有关，而这些特征难以评估。黑色素瘤的预后最差；平滑肌瘤尽管组织学表现为良性，但可能像肉瘤一样生长。18例患者有腹股沟转移，其中只有2例在直肠切除术后2年半和3年半时仍存活；肿瘤的大小和组织学类型与生存率低无关。根据这一经验，直肠切除术是治疗所有肛管肿瘤和大多数肛缘肿瘤最有效的方法。单纯放疗会带来不可接受的放射性直肠炎高风险。
