肛管鳞癌的诊断与治疗(附15例分析)

Diagnosis and Treatment of 15 Patients with Anal Squamous Carcinoma

目的探讨肛管癌诊断、治疗和预后的相关因素。方法北京医院1984-1998年间收治15例肛管鳞癌,首次诊断为肛管癌者仅5例。15例中行放疗化疗11例,8例行Miles手术。结果病理均证实为鳞癌。根据NCCN(2003年)分期,Ⅰ期6例,Ⅱ期4例,ⅢA期2例,ⅢB期3例。免疫组织化学染色显示肿瘤组织间质纤维化(+++)者4例,(++)者7例,(+)者4例。随诊最长10年,平均生存期(47±27.6)个月。结论肛门指诊是发现和诊断肛管癌的重要手段。放疗以及以放疗为主,化疗、手术为辅的综合治疗是肛管癌的主要治疗方法。肿瘤分期、腹股沟淋巴结转移、治疗方法以及肿瘤组织间质纤维化对病人的预后均有影响。

Objective To investigate the factors related to diagnosis and treatment, 15 patients with anal squamous carcinoma were analyzed. Methods 15 patients with anal squamous carcinoma were in our hospital during 1984 - 1998, Only 5 patients were diagnosed as cancer of anal canal in first time. In these 15 patients, 11 received radiotherapy and chemotherapy ,8 received Miles operation. Results 15 patients with anal squamous carcinoma were proven by pathologic examination,6 in NCCN （2003） stage Ⅰ , 4 in stage Ⅱ , 2 in stage ⅢA, 3 in stage ⅢB. Interstitial fibrosis of tumor tissue was shown by immunohistochemistry, （ ＋ ＋ ＋ ） was in 4 patients, （ ＋ ＋ ） in 7 ones, （ ＋ ） in 4 ones. The patients were followed in 10 year, average of survival time was （47 ± 27.6） months. Conclusion Anus digital examination was emphasized for finding and diagnosis of the anal carcinoma. Radiotherapy and combined therapy including radiotherapy, chemotherapy and surgery are important treatments of the anal carcinoma. Staging, metastasis of inguinal lymph nodes, treatment, and interstitial fibrosis of tumor tissue affect the prognosis of anal squamous carcinoma patients.