排便機能を温存できた肛門周囲Paget病の1例

A Case of Perianal Pagetʼs Disease in which Anal Function was Preserved

はじめに

　乳房外Paget病は，表皮内および皮膚付属器内に限局している表皮内癌である。肛門周囲に認めるものは乳房外Paget病の5 ％以下とまれであり 1）～4），その治療方法について検討した報告は少ない 3）4）。外科的治療が中心となるが，肛門周囲Paget病の場合は排便機能の温存を考慮した術式や術後管理を検討しなければならない。今回，われわれは排便機能を温存できた肛門周囲Paget病の1例を経験したので，文献的考察を交え報告する。

　We describe the case of a patient with perianal Pagetʼs disease whose anal function was preserved with the following method. The patient was an 81-year-old male. A relatively well-defined erythema of approx. 5×7cm in full circumference was observed around the patientʼs anal area. The lesion extended into the anal canal, partially reaching the dentate line. Following a thorough examination, a preoperative diagnosis of primary perianal Pagetʼs disease was established. A wide excision was performed, followed by reconstruction using bilateral V-Y advancement flaps. On the anal side, the lesion was excised submucosally in full circumference while preserving the anal sphincter, and the lesion was excised 1.5 cm away from the dentate line towards the oral side. Due to positive margins on the anal side, an ileostomy was constructed, followed by an additional excision 1 cm oral to the rectal resection margin for anal reconstruction. Compression therapy with a urethane foam pressure pad was initiated postoperatively. Artificial anal closure surgery was performed 6 months later. Currently, 1.5 years after the additional excision surgery, the patientʼs anal function remains satisfactory for daily activities without significant impairment, indicating a good outcome. This case demonstrates that (i) the patient satisfaction level after this treatment method is high, and (ii) preserving anal function is crucial for patientsʼ quality of life.