Perkowski P E, Sorrells D L, Evans J T, Nopajaroonsri C, Johnson L W
Department of Surgery, Louisiana State University Health Science Center, Shreveport, USA.
Am Surg. 2000 Dec;66(12):1149-52.
This report details the clinical course of two patients with true anal duct carcinoma. The incidence of this malignancy is low. The tissues of origination are the glands of the anal duct. The features that differentiate this tumor from the usual rectal carcinoma are prominent ductal structures, abundant mucin production with organized mucinous pools, and infiltration into the perirectal soft tissue. The clinical management of anal duct carcinoma remains a surgical challenge. The extent of surgical resection must be radical because of the infiltrative nature of the tumor. This report describes treatment of two patients with anal duct carcinoma. The first patient was a black woman with no previous history of rectal disease. Her operative procedure was an abdominoperineal resection with posterior vaginectomy. Nine months after initial surgery a local recurrence was resected. The second patient was a white man with a previous history of hemorrhoidectomy and anal fissure. He underwent an abdominoperineal resection but had positive dermal skin margins on permanent sections despite wide perirectal soft tissue resection. A secondary resection with confirmed clear margins of the skin was performed 2 weeks postoperatively. One management aspect of anal duct carcinoma that needs emphasis is the need for wide local excision of the perirectal soft tissues.
本报告详细介绍了两名真性肛管癌患者的临床病程。这种恶性肿瘤的发病率较低。其起源组织为肛管腺。该肿瘤与常见直肠癌的鉴别特征包括显著的导管结构、大量黏液分泌并形成有组织的黏液池，以及浸润至直肠周围软组织。肛管癌的临床治疗仍然是一项外科挑战。由于肿瘤具有浸润性，手术切除范围必须彻底。本报告描述了两名肛管癌患者的治疗情况。首例患者为一名黑人女性，既往无直肠疾病史。其手术方式为腹会阴联合切除术及后阴道切除术。初次手术后九个月，局部复发灶被切除。第二例患者为一名白人男性，既往有痔切除术及肛裂病史。他接受了腹会阴联合切除术，但尽管直肠周围软组织切除范围广泛，永久切片的皮肤切缘仍为阳性。术后两周进行了二次切除，皮肤切缘确认阴性。肛管癌治疗中一个需要强调的方面是直肠周围软组织需要广泛局部切除。
