Golden G T, Horsley J S
Am J Surg. 1976 Mar;131(3):275-80. doi: 10.1016/0002-9610(76)90115-x.
An analysis of twenty-six cases of epidermoid carcinoma of the anus from the University of Virginia Medical Center and 1,060 cases from the surgical literature has been presented. We believe this review justifies the following conclusions. (1) Considerable delay in diagnosis frequently occurs, adversely affecting the prognosis of patients with this disease. (2) Abdominoperineal resection remains the treatment of choice. Wide local excision is inadequate for most lesions, and should be reserved for lesions of the anal verge less than 2 cm in diameter with favorable histology, that is, low grade of malignancy. (3) Large lesions and those with a high grade of malignancy are associated with a poor prognosis, but even these patients may sometimes be cured with aggressive surgical excision. (4) Synchronous inguinal node metastases are associated with a poor prognosis, but an occasional patient may be cured by iliofemoral node dissection. (5) Iliofemoral node dissection is indicated for metachronous inguinal node metastases in the absence of distant spread. (6) Iliofemoral node dissection should not be performed if these nodes are not clinically involved with metastases. Approximately 70 per cent of these patients will not need this procedure and would therefore have this resection and its attendant morbidity unnecessarily.
本文分析了弗吉尼亚大学医学中心的26例肛门表皮样癌病例以及外科文献中的1060例病例。我们认为该综述可得出以下结论。（1）诊断常常出现相当大的延迟，对本病患者的预后产生不利影响。（2）腹会阴切除术仍然是首选治疗方法。广泛局部切除对大多数病变来说是不够的，应保留用于直径小于2厘米、组织学表现良好（即低恶性程度）的肛门边缘病变。（3）大的病变和高恶性程度的病变预后较差，但即使是这些患者，有时积极的手术切除也可能治愈。（4）同时性腹股沟淋巴结转移预后较差，但偶尔有患者可通过髂股淋巴结清扫治愈。（5）对于非同时性腹股沟淋巴结转移且无远处转移的情况，应进行髂股淋巴结清扫。（6）如果这些淋巴结在临床上未出现转移，则不应进行髂股淋巴结清扫。这些患者中约70%不需要此手术，因此将不必要地进行这种切除及其伴随的发病率。
