肛門部皮膚病変

Perianal Skin Disease for Anorectal Surgeons

要旨　外科臨床で遭遇することのある皮膚病変として腫瘍性疾患のうちでPaget病とBowen病を，ウイルス性疾患のうちでBowenoid papulosisと尖圭コンジローマを取り上げた．Paget病は紅斑，びらん面を呈し，病巣の範囲は予想以上に広く，広範囲切除が必要であるが肛門機能保全とのジレンマがつきまとう．Bowen病の場合はこれに比べるとより小範囲の切除で間に合う．近年注目されるようになったBowenoid papulosisの病理組織はBowen病と同様であるが，その本態はヒト乳頭腫ウイルス（HPV l6）による感染症と考えられており，保存的治療でよいことを述べた．もう1つのウイルス感染症（HPV 6，11）である尖圭コンジローマは直腸内にも病変の及ぶことがあり注意を要する．

　Some skin conditions are encountered in the daily practice of the anorectal surgeon. Paget's disease, Bowen's disease, Bowenoid papulosis and condyloma acuminate are discussed here for their clinical importance.

　Clinical feature of Paget's disease is apparantly non specific erythema or erosion. It has an unexpectedly wide lateral spread as one of its clinical features. Wide local excision is the treatment of choice but preservation of anal function is also critical. So the resection margin must be carefully decided case by case from various points of view. More conservative surgery is sufficient for perianal Bowen's disease.

　Bowenoid papulosis is a recently recognized viral infectious disease and not a tumorous condition. Conservative treatment is sufficient for Bowenoid papulosis. Some cases of condyloma acuminate show rectal lesion and may be resistant to treatment.