Irie Naoko, Matsuyama Takatoshi, Sugino Aoi, Chikatani Kenichi, Chika Noriyasu, Hatano Satoshi, Kumagai Yoichi, Mochiki Erito, Ishida Hideyuki
Dept. of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1687-1689.
The patient is a 73-year-old man who was diagnosed with perianal Paget's disease by skin biopsy. Biopsy from the dentate line did not show any tumor cells. The patient was considered to undergo sphincter-preserving local resection and subsequently underwent the procedure. Histopathological examination of the resected specimen revealed perianal Paget's disease with a positive anorectal margin. The patient was referred to our department due to postoperative anal stenosis. On the 32nd postoperative day, a double barreled sigmoid colostomy was performed. However, considering the inability to adequately check for detect due to anorectal stenosis and the expected unfavorable anorectal function caused by sphincter- preserving re-operation, a robot-assisted abdominoperineal resection(D1)was performed 7 months after the initial surgery. Histopathological examination of the resected specimen revealed no residual tumor cells in the resected specimen. After local excision for perianal Paget's disease, the skin of the buttock becomes scarred due to skin valve formation and skin grafting, making closure of the perineal wound difficult when performing abdominoperineal resection. In robot-assisted surgery, it is relatively easy to remove the anorectal muscles from the abdominal cavity and reach the sciatico-rectal fossa, thus reducing the size of the perineal wound.
该患者为一名73岁男性，经皮肤活检诊断为肛周佩吉特病。齿状线活检未发现任何肿瘤细胞。该患者被考虑行保留括约肌的局部切除术，随后接受了该手术。切除标本的组织病理学检查显示为肛周佩吉特病，肛直肠切缘阳性。患者因术后肛门狭窄转诊至我科。术后第32天，行双腔乙状结肠造口术。然而，考虑到由于肛直肠狭窄无法充分检查以及保留括约肌的再次手术预期导致的不良肛直肠功能，在初次手术后7个月进行了机器人辅助腹会阴切除术（D1）。切除标本的组织病理学检查显示切除标本中无残留肿瘤细胞。肛周佩吉特病局部切除后，由于皮瓣形成和植皮，臀部皮肤会形成瘢痕，在行腹会阴切除术时会阴伤口难以闭合。在机器人辅助手术中，从腹腔切除肛直肠肌并到达坐骨直肠窝相对容易，从而减小了会阴伤口的大小。
