肛管-穴肛原癌二例及近二十年国内文献分析

Cloacogenic Carcinoma of Anal Canal:A Report of 2 Cases and A Review of the Literature in the Past 20 Years

目的 对肛管 -穴肛原癌的临床资料进行分析 ,以提高对该病的诊疗水平。方法 分析我院 2例及 1980年以来以国内报道的 3 2例肛管 -穴肛原癌资料。结果 ①该病的发病率男性略高 (男女之比为 1 2∶1)。多主诉类似肛管癌或直肠癌的症状 ,如便血、肛门下坠感及肛门疼痛。直肠指诊在齿状线上下扪及直肠肿物 ;②基底细胞样癌是最多见的病理组织学类型 ,其次是移行细胞癌 ;③治疗首选经腹会阴直肠切除术 (Miles手术 ) ,并根据病期早晚及有无淋巴转移 ,确定是否辅助放疗和 (或 )化疗 ;④本组病例 2年生存率为 76% (19/2 5 ) ,5年生存率为 3 2 % (8/2 5 )。结论 肛管 -穴肛原癌的确诊需经手术切除和病理组织学检查。它在确诊时多为进行期病变 ,其组织学类型及分化程度是影响预后的主要因素。

Objective The purpose of this paper was to analyze the clinical manifestations,so that diagnosis may be made and reatment preformed as early as possible.Methods 32 cases of cloacogenic carcinoma reportedin the literature in the past 20 years and 2 cases from our hospital were reviewed.Results ①the incidece of this disease was slightly higher in male than that in female (the ration 1.2∶1).Most patients complained something like lower rectal or anal cancer,such as bloody stool,anal pain,and so forth.The tumors were palpable by digital examination around the dentated line;②basaloid cancer was the most common histopathologicla type ,followed by transitional cell carcinomal;③abdominoperipectal resection(Mile's operation)was the first choice for this disease and combined radiotherapy and/or chemotherapy,according to the staging and presence or absenceof lymph node metastasis;④For recorded patients,the 2 year survival rate was 76.0% (19/25) and 5 year survival 32.0% (8/25).Conclusions The diagnosis of cloacogenic carcinoma was determined by surgery and histopathological examination.When diagenosed,the cases usually were in advanced stages,and histopathological type and differentiation were important prognostic factors for cloacogenic carcinoma.the operation was most chief treatment porotocol.