Johnstone Andrew A, Silvera Richard, Goldstone Stephen E
1 Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York 2 Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Dis Colon Rectum. 2015 Jan;58(1):45-52. doi: 10.1097/DCR.0000000000000241.
Perianal high-grade dysplasia (Bowen disease) is traditionally treated with mapping and wide excision with possible grafting rather than local ablation.
The aim of this study is to examine the results of high-grade perianal dysplasia ablation.
Data for this study were derived from a retrospective chart review at a surgical practice screening and treating patients for high-grade dysplasia between July 1998 and June 2013.
The patients included were men who have sex with men and are undergoing perianal dysplasia ablation.
Ablation of perianal dysplasia with electrocautery, laser, or infrared coagulation was performed.
The primary outcomes measured were the recurrence of perianal dysplasia postablation and factors affecting recurrence.
Seventy HIV-positive and 11 HIV-negative patients enrolled; the median ages were 44.7 and 42.8 years. Median follow-up times for HIV-positive and HIV-negative patients were 4.62 and 3.53 years, and the median numbers of treatments were 4 and 1, p = 0.004. The median number of lesions treated was 1 for both groups. Only 1 HIV-negative patient had a recurrence 8 months after treatment. For HIV-positive patients, the Kaplan-Meier probability of recurrence at 1, 3, and 5 years was 38% (95% CI 26-50), 59% (95% CI 47-72), and 68% (95% CI 55-81) after the first ablation with no difference for subsequent treatments. HIV-positive patients had a relative risk of perianal high-grade squamous intraepithelial lesions of 3.72 (95% CI 2.10-6.60) compared with HIV-negative patients (p ≤ 0.0001). In multivariate analysis, only each increase in intra-anal high-grade squamous intraepithelial lesions significantly increased recurrence (HR 1.13, 95% CI 1.00-1.28, p = 0.002). Only 3 patients with perianal high-grade squamous intraepithelial lesions did not have canal dysplasia. Perianal cancer developed in 3 after being lost to follow-up.
This is a retrospective analysis of 1 experienced surgeon's results. No precise way exists to accurately determine the size of the disease.
Perianal dysplasia can be successfully ablated, but recurrence remains high. Almost all patients have anal canal dysplasia. HIV-positive patients are at the greatest risk for disease and recurrence. An increased number of high-grade canal lesions increases recurrence.
肛周高级别发育异常（鲍恩病）传统上采用定位和广泛切除并可能进行植皮治疗，而非局部消融。
本研究旨在探讨肛周高级别发育异常消融的结果。
本研究数据来自于一家外科诊所1998年7月至2013年6月期间对高级别发育异常患者进行筛查和治疗的回顾性病历审查。
纳入的患者为男男性行为者且正在接受肛周发育异常消融治疗。
采用电灼、激光或红外线凝固进行肛周发育异常消融。
测量的主要结局为消融后肛周发育异常的复发情况以及影响复发的因素。
70例HIV阳性患者和11例HIV阴性患者入组；中位年龄分别为44.7岁和42.8岁。HIV阳性和HIV阴性患者的中位随访时间分别为4.62年和3.53年，中位治疗次数分别为4次和1次，p = 0.004。两组治疗的病损中位数量均为1个。仅1例HIV阴性患者在治疗后8个月复发。对于HIV阳性患者，首次消融后1年、3年和5年的复发的Kaplan-Meier概率分别为38%（95%CI 26-50）、59%（95%CI 47-72）和68%（95%CI 55-81），后续治疗无差异。与HIV阴性患者相比，HIV阳性患者发生肛周高级别鳞状上皮内病变的相对风险为3.72（95%CI 2.10-6.60）（p≤0.0001）。多因素分析中，仅肛管内高级别鳞状上皮内病变每增加一处，复发显著增加（HR 1.13，95%CI 1.00-1.28，p = 0.002）。仅3例肛周高级别鳞状上皮内病变患者无肛管发育异常。3例患者失访后发生肛周癌。
这是对1名经验丰富外科医生的结果进行的回顾性分析。不存在准确确定疾病范围的精确方法。
肛周发育异常可成功消融，但复发率仍然很高。几乎所有患者都有肛管发育异常。HIV阳性患者疾病和复发风险最高。肛管高级别病变数量增加会增加复发率。
