Daniel G L, Longo W E, Vernava A M
Department of Surgery, St. Louis University School of Medicine, Missouri 63110-0250.
Dis Colon Rectum. 1994 Jul;37(7):670-4. doi: 10.1007/BF02054410.
The aim of this study was to determine how frequently pruritus ani (PA) is a symptom secondary to benign or malignant colon and anorectal pathology.
One hundred nine patients with PA as the only presenting symptom were prospectively evaluated over a two-year period. All patients underwent anoscopy, rigid proctoscopy, and colonoscopy and were treated for PA. Patient data were entered into a computer data base and analyzed.
The mean age was 52.1 years; males outnumbered females 2:1. The mean duration of symptoms was 6.1 weeks. Mean coffee intake was four cups per day. Forty-five percent of patients smoked and 45 percent drank alcohol daily. Thirty-five percent had an abnormal proctosigmoidoscopy or colonoscopy. Twenty-seven (25 percent) patients had primary pruritus and 82 (75 percent) patients had coexisting colon or anorectal pathology. The PA-associated neoplasia included rectal cancer (11 percent), anal cancer (6 percent), adenomatous polyps (4 percent), and colon cancer (2 percent). Hemorrhoids (20 percent) and anal fissures (12 percent) were the most common pruritus-related anorectal diseases. Among the 23 percent of patients with PA and neoplasia, pruritic symptoms were present longer compared with those with PA and anorectal disease < 0.001 and primary pruritus (P < 0.0001). All patients with primary PA were initially treated with dietary fibers, steroid cream, and drying agents. The recurrence rate for primary pruritus was twice that for anorectal disease (P < 0.0001).
PA responds to treatment in 89 percent of patients, while 11 percent are refractory to treatment. Symptoms suggestive of pruritus ani, especially those of long duration, should alert the surgeon to the potential for proximal colon and anorectal neoplasia.
本研究旨在确定肛门瘙痒（PA）作为良性或恶性结肠及肛肠疾病继发症状的发生频率。
对109例以PA为唯一症状的患者进行了为期两年的前瞻性评估。所有患者均接受了肛门镜检查、硬性直肠镜检查和结肠镜检查，并针对PA进行了治疗。患者数据被录入计算机数据库并进行分析。
平均年龄为52.1岁；男性与女性的比例为2:1。症状的平均持续时间为6.1周。平均每日咖啡摄入量为4杯。45%的患者吸烟，45%的患者每日饮酒。35%的患者直肠乙状结肠镜检查或结肠镜检查结果异常。27例（25%）患者患有原发性瘙痒，82例（75%）患者同时存在结肠或肛肠疾病。与PA相关的肿瘤包括直肠癌（11%）、肛管癌（6%）、腺瘤性息肉（4%）和结肠癌（2%）。痔疮（20%）和肛裂（12%）是最常见的与瘙痒相关的肛肠疾病。在23%患有PA和肿瘤的患者中，瘙痒症状出现的时间比患有PA和肛肠疾病的患者更长（P<0.001），与原发性瘙痒相比也是如此（P<0.0001）。所有原发性PA患者最初均接受膳食纤维、类固醇乳膏和干燥剂治疗。原发性瘙痒的复发率是肛肠疾病的两倍（P<0.0001）。
89%的PA患者对治疗有反应，而11%的患者对治疗无效。提示肛门瘙痒的症状，尤其是持续时间较长的症状，应提醒外科医生注意近端结肠和肛肠肿瘤的可能性。
