Section of Colon and Rectal Surgery, Department of Surgery, Kaiser Permanente, 4760 Sunset Boulevard, Los Angeles, CA, USA.
Tech Coloproctol. 2011 Sep;15(3):313-8. doi: 10.1007/s10151-011-0715-3. Epub 2011 Jul 9.
This study aimed to evaluate the outcome of patients with Buschke-Löwenstein tumor or circumferential anal carcinoma in situ who underwent wide local excision with flap or skin graft coverage of the wound.
A retrospective review was conducted of all patients operated at Kaiser Permanente Los Angeles Medical Center during a 6-year period. Outcome measures included postoperative complications, functional results, recurrence rate, and re-intervention rate.
Of 152 patients operated for dysplastic anal lesions or tumors, 10 (7%) underwent wide local excision for Buschke-Löwenstein tumor or circumferential anal carcinoma in situ [men 70%, mean age 36 years]. Median duration of symptoms was 5 years. Eighty percent of patients had prior operations and 50% were positive for the human immunodeficiency virus. Mean size of the lesion was 41 cm(2). Microscopic margin positivity was noted in 60%. Wound was closed with house advancement flap in majority of patients. Only one patient had fecal diversion. Median length of stay was 2 days. Postoperative complications were noted in 50% of patients. Rate of transient postoperative incontinence was 30%. Recurrent disease was noted in 3 patients with the human immunodeficiency virus [median follow-up: 18 months]. All recurrences were treated with local fulguration or medication.
Wide local excision with flap or skin graft coverage is an option for patients with Buschke-Löwenstein tumor or circumferential anal carcinoma in situ. Close postoperative surveillance is advised due to the risk of recurrent disease, especially in patients with the human immunodeficiency virus.
本研究旨在评估接受广泛局部切除加皮瓣或植皮覆盖创面的 Buschke-Löwenstein 肿瘤或环状肛门原位癌患者的治疗效果。
回顾性分析了在 6 年期间在 Kaiser Permanente Los Angeles Medical Center 接受手术的所有患者。观察指标包括术后并发症、功能结果、复发率和再次干预率。
在因发育不良性肛门病变或肿瘤而接受手术的 152 例患者中，有 10 例（7%）接受广泛局部切除治疗 Buschke-Löwenstein 肿瘤或环状肛门原位癌[男性占 70%，平均年龄 36 岁]。中位症状持续时间为 5 年。80%的患者曾接受过手术，50%的患者人类免疫缺陷病毒（HIV）检测阳性。病变平均大小为 41cm²。60%的患者切缘组织病理学检查阳性。多数患者采用经肛门内括约肌切开术皮瓣转移闭合创面。仅 1 例患者行肠造口术。中位住院时间为 2 天。50%的患者发生术后并发症。暂时性术后失禁发生率为 30%。3 例 HIV 阳性患者出现疾病复发[中位随访时间：18 个月]。所有复发患者均接受局部电灼或药物治疗。
对于 Buschke-Löwenstein 肿瘤或环状肛门原位癌患者，广泛局部切除加皮瓣或植皮覆盖是一种选择。由于疾病复发的风险，尤其是在 HIV 阳性患者中，建议进行密切的术后随访。
