慢性肛瘘演变的粘液腺癌四例临床分析  

Mucinous adenocarcinoma deriving from chronic anal fistula: a report of 4 cases

作　　者：杨晓东 左敏 尹伯约[3] 

机构地区：[1]深圳市人民医院普外科,518020 [2]深圳市人民医院病理科,518020 [3]甘肃省人民医院肛肠科

出　　处：《中华普通外科杂志》2000年第11期655-656,共2页Chinese Journal of General Surgery

摘　　要：目的　了解慢性肛瘘演变为粘液腺癌的生物学特性 ,探讨其诊断和治疗。方法　回顾性总结 1986～ 1997年我院收治的肛门直肠恶性肿瘤中 ,4例由慢性肛瘘演变而来的肛门粘液腺癌的临床和病理资料。结果　本组患者男 3例 ,女 1例 ,平均年龄 5 0岁。有长期肛周脓肿或肛瘘病史 ;肛瘘及其相关的肛腺是这种罕见肿瘤的原发部位 ,反复发作的慢性炎症刺激和瘢痕组织变异为诱发肛瘘癌变的主要原因。肿瘤确诊依靠瘘管及相关肿物的病理学活检。本组 2例腹股沟淋巴结有转移。3例行Miles根治术的患者中 ,2例同时行腹股沟淋巴结清扫 ,并辅以化疗 ,生存期在 5年以上 ;1例未行根治手术仅单纯化学药物治疗者 3个月后死亡。结论　继发于肛瘘的粘液腺癌 ,与原发性肛管直肠粘液腺癌相比 ,病程发展慢 ,恶性程度相对较低 ,预后较好。Objective To explore the biological characteristics of mucinous adenocarcinoma deriving from chronic anal fistula and its diagnosis and treatment. Method A retrospective study was made to analyze clinical and pathological features of 4 cases of chronic anal fistula from which mucinous adenocarcinoma developed in our hospital from 1986 to 1997. Results There were three males and one female averaging 50 years old. All patients had chronic history of perianus abscess or anal fistula. This rare mucinous adenocarcinoma originated from the anal fistula and the associated anal glands. The canceration of anal fistula was due to chronic inflammation and scarring. The definitive diagnosis of the carcinoma depends on biopsy of the fistula and the related tumor. Metastasis to groin lymph nodes was found in two patients. Three cases underwent Miles operation with chemotherapy; two of the three patients also had resection of groin lymph nodes. Three patients survived more than five years. One patient treated only with chemotherapy died three months later. [WT5”HZ] Conclusion [WT5”BZ] Mucinous adenocarcinoma following chronic anal fistula is less malignant and has better prognosis compared to primary rectal and anal mucinous adenocarcinoma.

关 键 词：粘液腺癌 慢性肛瘘 生物学特征 诊断 治疗 

分 类 号：R657.160.6[医药卫生—外科学] R735.38[医药卫生—临床医学]