Guttadauro Angelo, Chiarelli Marco, Macchini Daniele, Frassani Silvia, Maternini Matteo, Bertolini Aimone, Gabrielli Francesco
Istituti Clinici Zucchi, Università degli Studi Milano-Bicocca, Milan, Italy.
Dis Colon Rectum. 2015 Apr;58(4):e49-52. doi: 10.1097/DCR.0000000000000339.
Perianal giant condyloma acuminatum is a rare clinical condition related to human papillomavirus infection and characterized by a circumferential, exophytic, cauliflower-like mass with an irregular warty surface localized in the anal region.
A circular incision with a diathermocoagulator was performed on macroscopically healthy skin, 1 cm from the margin of the lesion. The dermis was divided from the subcutaneous tissue. This way, a mucocutaneous cylinder including the whole lesion was obtained. A median radial incision was carried out to open the cylinder at its front. A progressive circumferential section on healthy mucosa (≈1 cm above the margin of the lesion) by means of a radiofrequency dissector allowed for the complete removal of the mass. The healthy mucosa of the anal canal was pulled out by Allis forceps and was sutured to the external margin of the internal sphincter with single layer of Vicryl (polyglactin 910) 2-0 sutures.
Two months after surgery, no findings of anal stenosis or mucosal ectropion were reported. At the 1-year follow-up there was no recurrence of condylomatosis in any of the 3 cases.
Our procedure seems simpler to perform when compared with other techniques and reduces hospital stay and complications such as anal stenosis and mucosal ectropion.
肛周巨大尖锐湿疣是一种与人类乳头瘤病毒感染相关的罕见临床病症，其特征为位于肛门区域的环形、外生性、菜花状肿物，表面呈不规则疣状。
在距病变边缘1厘米的肉眼可见健康皮肤上，使用高频电刀进行环形切口。将真皮与皮下组织分离。通过这种方式，获得了一个包含整个病变的黏膜皮肤圆柱体。在圆柱体前端进行正中放射状切口以打开它。借助射频剥离器在健康黏膜（病变边缘上方约1厘米处）进行渐进性环形切除，从而完全切除肿物。用艾利斯钳将肛管的健康黏膜拉出，并用单层2-0薇乔（聚乙醇酸910）缝线缝合至内括约肌的外缘。
术后两个月，未报告肛门狭窄或黏膜外翻的情况。在1年的随访中，3例患者均未出现湿疣复发。
与其他技术相比，我们的手术方法似乎操作更简单，且可缩短住院时间，并减少诸如肛门狭窄和黏膜外翻等并发症。
