Sato H, Maeda K, Maruta M, Kuroda M, Nogaki M, Nogaki M
Department of Surgery, Fujita Health University Kutsukake-cho, Toyoake, Japan.
Tech Coloproctol. 2006 Oct;10(3):249-52. doi: 10.1007/s10151-006-0289-7. Epub 2006 Sep 20.
Mucinous adenocarcinoma associated with chronic anal fistula is extremely rare, and such tumors have often reached an advanced stage at the time of presentation. Here we report a case of mucinous adenocarcinoma associated with chronic anal fistula that involved repair with gracilis myocutaneous flaps and review other reported cases. A 67-year-old man with an approximate 30-year history of an anal fistula was referred to our hospital due to enlargement of the perianal induration accompanied by mucinous secretion and pain. Physical examination of the perianal region revealed an ulcerated and discharging lesion on the buttocks. Histologic examination of a biopsy specimen of the ulcerated lesion revealed mucinous adenocarcinoma. An abdominoperineal resection was performed with resection of the ischiorectal fossa, coccyx, part of the gluteus maximus, and the obturator internus. The extensive defect was repaired with bilateral gracilis myocutaneous flaps. The patient did not experience a decrease in the strength of hip adduction and survived for 58 months without recurrence until he died of pneumonia. The repair using myocutaneous flaps was considered to contribute to a physically active life without recurrence.
黏液性腺癌合并慢性肛瘘极为罕见，此类肿瘤在就诊时往往已处于晚期。本文报告1例黏液性腺癌合并慢性肛瘘的病例，该病例采用股薄肌肌皮瓣进行修复，并对其他报道的病例进行回顾。一名有近30年肛瘘病史的67岁男性因肛周硬结增大伴黏液分泌和疼痛转诊至我院。肛周区域体格检查发现臀部有一处溃疡且有分泌物的病变。对溃疡病变活检标本进行组织学检查显示为黏液性腺癌。行腹会阴联合切除术，切除坐骨直肠窝、尾骨、部分臀大肌和闭孔内肌。广泛缺损用双侧股薄肌肌皮瓣修复。患者髋内收肌力未减退，存活58个月无复发，直至死于肺炎。肌皮瓣修复被认为有助于患者过上无复发的积极生活。
