慢性肛瘘癌变：附6例临床分析

目的：了解慢性肛瘘癌变的临床病理特征。方法：回顾性总结1996—2005年收治的6例由慢性肛瘘演变而来的肛管癌的临床和病理资料。结果：男5例，女1 例;中位年龄55岁。有慢性肛瘘病史15～30年;反复发作的慢性炎症刺激为肛瘘癌变的主要诱因。肿瘤确诊依靠瘘管及周围肿块的病理学活检。其中3例伴有腹股沟淋巴结转移。所有患者均行腹会阴联合根治术, 3例同时行腹股沟淋巴结清扫, 术后均辅以化疗。3例患者生存期在5 年以上，1例已存活3年，1例存活1年， 1例手术1年后死于肺转移。结论：肛瘘继发癌变,病程发展慢,恶性程度相对较低,但易被漏诊。治疗应采用以腹会阴根治性切除术为主的综合治疗。

Cancerous change in chronic anal fistula:a report of 6 cases

Abstract:Objective：To explore the clinical and pathological characteristics of cancer deriving from chronic non-Crohn′s disease anal fistula. Methods：A retrospective study was made to analyze clinical and pathological data of 6 cases of chronic anal fistula from which cancer developed and were treated in our hospital from 1996 to 2005. Results：There were 5 males and 1 female averaging 55 years of age. The patients had chronic history of anal fistula for 15～30 years. The anal fistula carcinogenetic factor was chronic inflammation. The definitive diagnosis of the carcinogenesis depended on biopsy of the fistula wall and perianal mass. Metastasis to inguinal lymph nodes was found in 3 patients. All cases underwent abdomino-perineal radical resection(Miles operation )with adjuvant chemotherapy; three patients also had excision of inguinal lymph nodes. Three patients survived more than 5 years, two patients have survived for 3 years and 1 year respectively; 1 patient died of lung metastasis 1 year after operation later. Conclusions：Cancer deriving from chronic anal fistula develops slowly, is of relatively low malignancy but can be ignored easily in the early stage. Combined treatment in which the abdomino-perinal radical resection is the major method should be taken.