Metcalf A M, Dean T
Department of Surgery, University of Iowa Hospital, Iowa City 52242-1086, USA.
Surgery. 1995 Oct;118(4):724-6. doi: 10.1016/s0039-6060(05)80041-8.
Recent studies suggest an alarming incidence of dysplasia in homosexuals with anal condyloma. The purpose of our study was to determine the incidence of dysplasia in anal condyloma in our male patients and to determine risk factors for premalignant or malignant change.
Between 1986 and 1994, 103 male patients were referred to our colorectal clinic for evaluation of anal condyloma. Ninety-one patients had biopsy for pathology and form the basis of this report. All charts were reviewed and results analyzed using the chi-squared test with the Yates correction factor.
Mean patient age was 31 +/- 11 years (range, 13 to 78 years) and mean duration of disease was 20 +/- 26 months (range, 2 to 120 months). There were 59 heterosexuals and 32 homosexuals/bisexuals. Two heterosexuals (3%) had invasive squamous cell carcinoma and four (6%) had dysplasia. One homosexual/bisexual (3%) had squamous cell carcinoma in situ and nine (28%) had dysplasia (p < 0.05). Statistical analysis revealed that HIV seropositive status and disease location above the dentate line also predicted increased risk of dysplasia, whereas duration of disease, previous topical therapy, substance abuse, and other sexually transmitted diseases were not significant risk factors.
Homosexual orientation, disease above the dentate line and HIV seropositivity increase the risk of dysplasia in perianal condyloma. The incidence of dysplasia in perianal condyloma is significant enough to warrant consideration of biopsy in all patients.
近期研究表明，患有肛门尖锐湿疣的同性恋者发育异常的发生率令人担忧。我们研究的目的是确定男性患者肛门尖锐湿疣发育异常的发生率，并确定癌前或恶性病变的危险因素。
1986年至1994年间，103名男性患者因肛门尖锐湿疣被转诊至我们的结肠直肠诊所进行评估。91名患者进行了病理活检，构成了本报告的基础。回顾了所有病历，并使用带有Yates校正因子的卡方检验分析结果。
患者平均年龄为31±11岁（范围13至78岁），平均病程为20±26个月（范围2至120个月）。其中59名是异性恋者，32名是同性恋者/双性恋者。两名异性恋者（3%）患有浸润性鳞状细胞癌，四名（6%）有发育异常。一名同性恋者/双性恋者（3%）患有原位鳞状细胞癌，九名（28%）有发育异常（p<0.05）。统计分析显示，HIV血清学阳性状态和齿状线以上的病变部位也预示着发育异常风险增加，而病程、既往局部治疗、药物滥用和其他性传播疾病不是显著的危险因素。
同性恋取向、齿状线以上的病变和HIV血清学阳性会增加肛周尖锐湿疣发育异常的风险。肛周尖锐湿疣发育异常的发生率足以值得对所有患者进行活检。
