肛门部尖锐湿疣

肛门尖锐湿疣是人类乳头瘤病毒引起的皮肤传染病，可通过性接触传染，也可由泡浴池、桑拿或受染的卫生纸、内裤等传染。发病早期肛门及周围皮肤瘙痒或无明显感觉，初发皮损为细小淡红的丘疹，长到米粒大，顶部角化，再长大融合成菜花样直至巨块状，长期不治疗可...能转为皮肤癌。详情别名：肛周湿疣肛门湿疣肛门尖锐湿疣英文名：condylomaacuminaturnofanus发病部位：肛门肛管肛周就诊科室：皮肤性病科症状：菜花样肿物丘疹乳头瘤样赘生物多发人群：青年中年男性治疗手段：肛门病损激光切除术皮肤病损冷冻治疗外用药系统治疗并发疾病：肛周皮肤恶性肿瘤鳞状细胞癌是否遗传：否是否传染：是

症状尖锐湿疣感染后潜伏期一般为3周～8个月，发病早期肛门及周围皮肤瘙痒或无明显感觉，初发皮损为细小淡红的丘疹，长到米粒大，顶部角化，再长大融合成菜花样直至巨块状，其根部常有蒂。如果继发感染或疣体内供血不足可有脱落、糜烂和溃疡形成。初起时可无明显不适，随着疣体增大可出现局部瘙痒、压迫感、轻微刺痛，肛管内发病者可有里急后重感，或便鲜血。表面若溃烂则渗出混浊浆液，带有恶臭。长期不及时治疗，可发生癌变。

病因本病因肛门部皮肤感染人类乳头瘤病毒所致，因该类病毒在人体潮湿温热部位容易生长繁殖，所以肛门生殖器部位是最常见发病部位之一。1、人类乳头瘤病毒的主要传染途径是直接通过性接触传染。2、少部分患者是通过接触经污染的内裤、浴盆、浴巾、便盆等间接接触感染本病。3、免疫力低下或长期的肛门部皮肤不洁或分泌物刺激、摩擦、皮肤慢性炎症性损害（如肛周湿疹、肛门瘙痒）等均可以降低局部皮肤的屏障作用，从而更容易感染该病毒。

检查<!--[ifgtemso9]><xml><w:WordDocument><w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel><w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery><w:DisplayVerticalDrawingGridEvery>2</w:DisplayVerticalDrawingGridEvery><w:DocumentKind>DocumentNotSpecified</w:DocumentKind><w:DrawingGridVerticalSpacing>7.8磅</w:DrawingGridVerticalSpacing><w:PunctuationKerning></w:PunctuationKerning><w:View>Normal</w:View><w:Compatibility><w:DontGrowAutofit></w:DontGrowAutofit><w:BalanceSingleByteDoubleByteWidth></w:BalanceSingleByteDoubleByteWidth><w:DoNotExpandShiftReturn></w:DoNotExpandShiftReturn><w:UseFELayout></w:UseFELayout></w:Compatibility><w:Zoom>0</w:Zoom></w:WordDocument></xml><![endif]--><pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">1.病毒检测<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">核酸杂交可检出HPV-DNA相关序列，PCR检测可见特异性HPV-DNA扩增区带。<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">2.肛门直肠镜检查<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">齿线上下和直肠末端，可见淡红色乳头状或菜花状柔软赘生物，质脆，触之易出血。<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">3.醋酸白试验<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">以5%醋酸溶液涂于会阴及肛门周围皮肤，3～5分钟后即可在HPV感染区域出现有光泽、均匀一致、界限清楚的变白区，用放大镜观察更为明显。但局部若有炎症，也可发白而出现假阳性。<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">4.病理组织学检查<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">可见棘层细胞组织高度肥厚，成乳头瘤样增生，上皮脚延长，有大量核分裂象，上皮细胞出现空泡化。电镜下可见嗜碱性细胞的胞核中有病毒颗粒。可辅助明确诊断及与癌变、肛门皮肤结核等鉴别。<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;"><pclass="MsoNormal"><!--[ifgtemso9]><xml><w:LatentStylesDefLockedState="false"DefUnhideWhenUsed="true"DefSemiHidden="true"DefQFormat="false"DefPriority="99"LatentStyleCount="260"><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="Normal"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="NormalIndent"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="footnotetext"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="annotationtext"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="header"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="footer"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="indexheading"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="fa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诊断(1)不洁性交史及肛交史。(2)典型皮损为生殖器或肛周等潮湿部位出现丘疹，乳头状、菜花状或鸡冠状肉质赘生物，表面粗糙角化。(3)醋酸白试验阳性，病理切片可见角化不良及凹空细胞。(4)核酸杂交可检出HPV-DNA相关序列，PCR检测可见特异性HPV-DNA扩增区带。(5)患者多有不洁性生活史或配偶感染史，少数通过接触污染的用具感染，新生儿亦可通过产道受感染。潜伏期1～8个月不等，平均为3个月。

治疗<!--[ifgtemso9]><xml><w:WordDocument><w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel><w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery><w:DisplayVerticalDrawingGridEvery>2</w:DisplayVerticalDrawingGridEvery><w:DocumentKind>DocumentNotSpecified</w:DocumentKind><w:DrawingGridVerticalSpacing>7.8磅</w:DrawingGridVerticalSpacing><w:PunctuationKerning></w:PunctuationKerning><w:View>Normal</w:View><w:Compatibility><w:DontGrowAutofit></w:DontGrowAutofit><w:BalanceSingleByteDoubleByteWidth></w:BalanceSingleByteDoubleByteWidth><w:DoNotExpandShiftReturn></w:DoNotExpandShiftReturn><w:UseFELayout></w:UseFELayout></w:Compatibility><w:Zoom>0</w:Zoom></w:WordDocument></xml><![endif]--><pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">1.局部药物治疗<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">初发较小者，可用腐蚀剂，如苯酚、足叶草酯、足叶草毒素、三氯乙酸、二氯乙酸、氟尿嘧啶霜等外抹患处，可促使疣体脱落，涂药时注意保护周围的正常皮肤与黏膜。亦可通过中医药辨证论治，用中药煎煮后熏洗患处。<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">2、物理疗法<pclass="MsoNormal"style="margin-top:0.0000pt;margin-right:0.0000pt;margin-bottom:0.0000pt;margin-left:0.0000pt;mso-pagination:widow-orphan;text-align:left;">（1）冷冻疗法是一种皮肤科常用的治疗方法，它是以液氮或二氧化碳干冰冷冻皮肤病损，使皮肤损害局部水肿、坏死，以达到治疗的目的。尖锐湿疣是由于尖锐湿疣病毒的感染，导致皮肤粘膜的良性增生。它有大量的小血管，增殖迅速。用冷冻的方法可使尖锐湿疣内结冰，形成组织局部的高度水肿，从而破坏疣体。冷冻治疗的最大好处是局部不留痕迹，治愈率约70％左右。可用喷雾法或直接接触法，适用于平坦较小的疣体。一般每周冷冻1次，连续2～3次。<pclass="MsoNormal"style="margin-top:0.0000pt;margin-right:0.0000pt;margin-bottom:0.0000pt;margin-left:0.0000pt;mso-pagination:widow-orphan;text-align:left;">（2）激光治疗是皮肤性病科常用的治疗尖锐湿疣的方法。它的特点是见效快，在治疗的当时，疣体即可脱落。常用的是二氧化碳激光，烧灼疣体，一般1次即可使疣体脱落。但是，由于激光的光束过于集中的原故，激光治疗只适用于疣体较小的尖锐湿疣，如疣体较大，激光治疗很容易复发。<pclass="MsoNormal"style="margin-top:0.0000pt;margin-right:0.0000pt;margin-bottom:0.0000pt;margin-left:0.0000pt;mso-pagination:widow-orphan;text-align:left;">（3）微波治疗是进入20世纪90年代后兴起的治疗方法。它的原理是利用微波的高频震动，使疣体内部水分蒸发，坏死脱落。微波治疗的特点是，疣体破坏彻底，不易复发，但创面恢复较慢，容易继发感染。所以微波治疗特别适用于治疗疣体较大的，孤立、散在的，同时要远离包皮系带的尖锐湿疣，以防损伤包皮系带，影响男性的性功能。<pclass="MsoNormal"style="margin-top:0.0000pt;margin-right:0.0000pt;margin-bottom:0.0000pt;margin-left:0.0000pt;mso-pagination:widow-orphan;text-align:left;">（4）电烧灼是较老的一种治疗方法。过去皮肤科医师常用高频电刀或电烙铁烧灼寻常疣、色素痣及其他皮肤赘生物。它的特点是操作简单，见效快。高频电刀能直接切除和干燥疣体，治疗也较彻底，但是，电烧灼疮面愈合较缓慢。综上所述，电烧灼治疗，可用于任何尖锐湿疣的治疗，但是对施术者的技术要求较高，烧灼太过或不足都是有害的。同时要注意无菌操作，预防感染。<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">3、免疫治疗<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">包括自体免疫法、抗病毒药、干扰素和转移因子等。其中，自体免疫法是通过将感染组织里的HPV病毒灭活，提取后注射于患者自身上，从而产生免疫力。免疫治疗常综合其他治法一起应用，尤其适用于反复发作者。<pclass="MsoNormal"style="margin-top:0.0000pt;margin-right:0.0000pt;margin-bottom:0.0000pt;margin-left:0.0000pt;mso-pagination:widow-orphan;text-align:left;">4、手术治疗尖锐湿疣一般不主张手术切除，因为手术治疗后，尖锐湿疣很容易复发，使治疗失败。但对带蒂的较大的疣体可考虑手术切除。有的患者尖锐湿疣生长过于迅速，或大如菜花，其他治疗十分困难，可考虑手术治疗。为防止复发，术后配合其他治疗。手术主要采取以下两种方法。<pclass="MsoNormal"style="margin-top:0.0000pt;margin-right:0.0000pt;margin-bottom:0.0000pt;margin-left:0.0000pt;mso-pagination:widow-orphan;text-align:left;">（1）结扎法对单个疣赘，其基底较小也可用结扎疗法，数日后疣赘可自行脱落，然后外用玉红膏，促使伤口愈合。<pclass="MsoNormal"style="mso-pagination:widow-orphan;text-align:left;">（2）切除法对于单发、面积小的湿疣，或湿疣堆积成团、基底较大者，可用手术切除，切除深度最好到真皮层。侵犯肛管全周的湿疣可一次性切除，切口之间应尽量保留正常皮桥，若切除组织较大，可选择合适皮瓣游离至齿线处缝合，以防术后肛管狭窄，还可离断内括约肌。<pclass="MsoNormal"><!--[ifgtemso9]><xml><w:LatentStylesDefLockedState="false"DefUnhideWhenUsed="true"DefSemiHidden="true"DefQFormat="false"DefPriority="99"LatentStyleCount="260"><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="Normal"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index7"></w:LsdE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预后1.肛周尖锐湿疣最棘手的是复发，约有25%～80%的患者会不同程度的复发，与潜伏感染的再活动及局部环境有关。2.本病与皮肤肿瘤有相关性，据统计，HPV6、11、16、18易发生皮肤鳞状细胞癌。

预防1.早发现早治疗，治疗后应注意有无复发，出现新皮疹时及时治疗。2.避免不洁性接触。与性伴侣同期检查，以防互相感染。肛周疣在未治愈前避免性生活，尤其是肛交。3.公共浴室的公共毛巾消毒要彻底，公共厕所要使用一次性纸巾隔离。患者就诊时，大夫检查必须使用一次性手套、一次性内窥器、一次性拭子，患者一人一坐垫，避免患者间交叉感染和医源性感染。

尖锐湿疣感染后潜伏期一般为3周～8个月，发病早期肛门及周围皮肤瘙痒或无明显感觉，初发皮损为细小淡红的丘疹，长到米粒大，顶部角化，再长大融合成菜花样直至巨块状，其根部常有蒂。如果继发感染或疣体内供血不足可有脱落、糜烂和溃疡形成。初起时可无明显不适，随着疣体增大可出现局部瘙痒、压迫感、轻微刺痛，肛管内发病者可有里急后重感，或便鲜血。表面若溃烂则渗出混浊浆液，带有恶臭。长期不及时治疗，可发生癌变。