Abel M E, Chiu Y S, Russell T R, Volpe P A
California Pacific Medical Center, San Francisco.
Dis Colon Rectum. 1993 Apr;36(4):383-7. doi: 10.1007/BF02053944.
Anal gland adenocarcinoma is rare, with information concerning this lesion communicated mostly as case reports. Cases seen by authors, combined with a survey of the membership of The American Society of Colon and Rectal Surgeons, allowed 52 cases with sufficient data for analysis. It became clear from the survey that most colorectal surgeons have not treated this malignancy. Predominant symptoms are anal pain (58 percent), rectal bleeding (40 percent), and the presence of perianal mass (37 percent). Fifty-four percent of patients present with a fistula, the incidence of fistula being significantly higher in males. Metastases, which may be inguinal, pelvic, or hepatic, are present at diagnosis in 13.5 percent of patients. Three-fourths of patients are eventually treated by abdomino-perineal resection (APR). Twelve percent of the patients in this series had an APR after a failed local excision. The conclusions from this study are: 1) if local excision is attempted, it must be complete, and the patient must be followed closely for many years, and 2) APR is needed in most patients for local control, with the role of subsequent radiation therapy and/or chemotherapy not yet defined.
肛门腺腺癌较为罕见，关于该病变的信息大多以病例报告的形式传达。作者所见到的病例，再结合对美国结直肠外科医师协会成员的一项调查，共得到52例有足够数据可供分析的病例。从调查中可以清楚地看出，大多数结直肠外科医生并未治疗过这种恶性肿瘤。主要症状为肛门疼痛（58%）、直肠出血（40%）和肛周肿块（37%）。54%的患者伴有肛瘘，男性肛瘘的发生率明显更高。转移可能发生在腹股沟、盆腔或肝脏，13.5%的患者在诊断时已有转移。四分之三的患者最终接受了腹会阴联合切除术（APR）。该系列中有12%的患者在局部切除失败后接受了APR。本研究的结论是：1）如果尝试进行局部切除，必须彻底切除，并且患者必须接受多年的密切随访；2）大多数患者需要进行APR以实现局部控制，后续放疗和/或化疗的作用尚未明确。
