Sawyers J L
Am Surg. 1977 Jul;43(7):424-9.
Malignant lesions of the anus and perianus account for 2.4% of malignant cancers of the colon, rectum, and anus. Based on our experience with 56 patients as well as a review of the recent literature, the following recommendations are made: Bowen's disease, Paget's extramammary disease, basal cell, and perianal epidermoid carcinomas arise in the perianus, rarely metastasize, and may be managed by wide local excision. Cloacogenic transitional cell (basaloid squamous carcinoma) and the more common epidermoid anal canal tumors require abdominoperineal resection with wide perineal excision. Therapeutic groin dissection is indicated if the inguinal nodes are or become the site of metastases, but prophylactic groin dissection is not indicated. The five-year survival for epidermoid carcinoma of anus treated by abdominoperineal resection ranges from 40 to 58%. Improvement in survival rate will require early recognition by the patient and early diagnosis and treatment by the physician. Delay in diagnosis occurs because cancer is not considered frequently enough as a possible cause for the patient's symptoms.
肛门和肛周恶性病变占结肠、直肠和肛门恶性肿瘤的2.4%。根据我们对56例患者的经验以及近期文献回顾，提出以下建议：鲍恩病、乳腺外佩吉特病、基底细胞癌和肛周表皮样癌起源于肛周，很少发生转移，可通过广泛局部切除进行治疗。泄殖腔源性移行细胞癌（基底样鳞状癌）和更常见的肛管表皮样癌需要行腹会阴联合切除术及广泛的会阴切除术。如果腹股沟淋巴结是或成为转移部位，则需进行治疗性腹股沟淋巴结清扫，但不建议进行预防性腹股沟淋巴结清扫。经腹会阴联合切除术治疗的肛管表皮样癌的五年生存率为40%至58%。生存率的提高需要患者早期识别以及医生早期诊断和治疗。诊断延迟是因为癌症作为患者症状可能病因的考虑不够频繁。
