儿童恶性血液病并发急性阑尾炎的处理及结果

目的探讨和总结小儿恶性血液病并发急性阑尾炎的治疗及手术时机。方法回顾分析19例小儿恶性血液病并发急性阑尾炎的临床资料,骨髓抑制、血像的特征、病情危急程度,选择治疗方法。结果19例并发阑尾炎患儿紧急手术切除7例;12例保守治疗,经积极抗生素,全身支持疗法,体温逐渐正常,腹痛缓解,腹部体症消失,B超检查恢复正常。结论小儿恶性血液病由于化疗,骨髓抑制并发阑尾炎是一个非常严重的并发症,处理不及时会造成严重后果,而手术时机的选择又非常关键,我们认为只有在紧急状况下(明显腹痛刺激症、肠梗阻等)可选择急诊手术。对那些恶性血液病伴阑尾多次发作或有包块形成者,待原发病稳定后也需作手术治疗,对于符合保守治疗条件者,一旦诊断明确,必须马上积极治疗,消除病灶。

The treatment result of appendicitis complicated in childhood hematologic malignancies

Objective To explore and sum up the appropriate treatment and the time for operation in the childhood malignant hematologic disorder complicated acute appendicitis. Method The clinical data including the severity of the marrow suppression.The critical condition of the patimts.The feature of the blood routine examination as well as whether the conservative therapy or surgery was selected,was analysed retrospectively. Result 7 children were operated in 19 children complicated with acute appendicitis(4 children under went Emergent operation.3 cases for intestinal perforation,one accompanied by peritonitis and the early stag of shock associated with infection).2 of the 4 children operated on Emergent had complication(including Abcess of Recessus retro rectum) while other 12 cases only received conservative therapy consisting of active supportive care combined autiviotics resulting in the temperature returning to the normal range remission of abdominal pain,disappearce of the abdominal signs and the,B type ultrasonic examination pattern normal gradually. Conclusion The acute appendicitis complicated in the duration of the intensive chemotherapy and severe marrow suppuration is a very severe complication in the childhood malignant hematologic disorders if it treated inappropriatedy.It can cause serious consequences.So,it's the key issue in deciding when it's the right time to do operation.We consider only in the Emergency Condition such as the patient has the signs of the peritoneal inflammation,the intestinal obstruction etc. These patients can undergo the Emergency Operation,otherwise,the operation should be delayed until the primary diseases have got stabilized for the patients with multiple episodes of appendicitis or mass formation.If the patients were considered as the right candidate for receiving the conservative therapy active supportive care should be initiated right away to eradicate the lesions.