白血病化疗后肛肠感染的诊断和治疗特点

目的：总结和讨论白血病患者化疗后出现肛肠感染时的诊断和治疗特点。方法：对36例出现肛肠感染表现的白血病患者的临床资料进行回顾分析。结果：其中15例表现为肛门直肠感染或脓肿形成,14例表现为阑尾炎,4例表现为局限性盲肠炎,3例表现为肛管坏死、肛门失禁。36例中33例进行了外科手术治疗,2例阑尾炎早期及1例盲肠炎不伴出血的患者行内科抗感染治疗。手术分别采用病变肠段切除吻合术、阑尾切除术、结肠造瘘直肠肛管感染旷置引流术、肛周脓肿切开引流肛瘘切开术等。所有病例均痊愈出院。外科手术治疗的33例中,经手术及病理检查证实为白血病盲肠浸润1例、阑尾浸润2例,其余为普通炎性感染或脓肿形成。结论：白血病化疗后出现肛肠感染的患者,以肛门直肠中、重度感染,急性阑尾炎和急性盲肠炎多见,通常病情较重,肛管直肠壁脓肿形成或溃烂、坏死,阑尾穿孔等概率高,出血风险大,术后并发症多。当诊断明确而内科治疗难以控制时,应积极进行外科手术治疗。围手术期妥善处理是手术成功的关键。

The diagnosis and treatment characteristic of colorectal and anal inflamation after chemotherapy for leukemia

Objective：To summarize and discuss the diagnosis and treatment of colorectal and anal inflamation after chemotherapy for leukemia.Methods：The clinical data of 36 patients suffering from colorectal and anal inflamation after chemotherapy for leukemia were retrospectively analyzed.Results：Including anal rectal infection or abscess（n=15）,appendicitis（n=14）,limited cecitis（n=4）,canal necrosis anal incontinence（n=3）.In this group,33 patients underwent surgical therapy,2 patients with early acute appendicitis and 1 patient with cecitis were given anti-infective treatment.The surgical procedures included bowel resection and anastomosis,appendectomy,colostomy,anal abscess drainage and fistulectomy.All patients recovered well.In the 33 patients with surgical treatment,one was Leukemia infiltrating the cecum,2 were Leukemia infiltrating appendix,and the other 30 were ordinary inflammatory infection or abscesses.Conclusion：It is shown that anorectal severe infection,acute appendicitis and cecitis often occur in patients after chemotherapy for leukemia.The condition is usually critical and hemorrhage is a major risk.When the diagnosis is clear and medical intervention does not work,it should be considered to perform operation.Different operations should be undertaken according to different situations.