Sun Daang,Yu Kechi,Yang Fengjie,et al.Diagnosis and treatment of acute abdomen in children with hematologic malignancies[J].Journal of Clinical Pediatric Surgery,2026,(05):472-476.[doi:10.3760/cma.j.cn101785-202412033]
儿童血液系统恶性疾病合并急腹症的诊治探讨
- Title:
- Diagnosis and treatment of acute abdomen in children with hematologic malignancies
- Keywords:
- Hematologic Malignancies; Acute Abdomen; Treatment; Child
- 摘要:
- 目的 探讨儿童血液系统恶性疾病合并急腹症的临床特征,明确其规范化处理方法。方法 回顾性分析2010年1月至2024年6月华中科技大学同济医学院附属同济医院小儿外科收治的40例血液系统恶性疾病合并急腹症患儿的临床资料,总结患儿一般情况、原发病类型、急腹症临床表现及类型、诊疗方案,并分析治疗效果。结果 40例患儿中男性35例、女性5例,中位年龄5岁3个月(1岁8个月至14岁);原发病以急性淋巴细胞白血病(20例,50.0%)、急性髓细胞白血病(9例,22.5%)为主。急腹症主要临床表现为右下腹固定疼痛(30例,75.0%)、发热(17例,42.5%)、恶心呕吐(15例,37.5%);主要类型为急性阑尾炎(含阑尾周围脓肿)25例(62.5%),其次完全性肠梗阻9例(22.5%)。根据病情采取急诊手术23例(57.5%)、超声引导下腹腔穿刺引流4例(10.0%)、保守治疗13例(32.5%)。手术组急腹症治愈率91.3%(21/23),院内死亡2例(8.7%);穿刺引流组4例均于术后1~2周内拔管,急腹症表现完全消失;保守治疗组13例经抗感染及对症治疗后均治愈。结论 儿童恶性血液病合并急腹症处理较复杂,需多学科综合治疗,合并完全性肠梗阻或消化道穿孔者需积极手术,而局限性阑尾炎或腹腔脓肿者可选择超声引导下经皮腹腔穿刺引流或静脉用药,均可取得好的效果。
- Abstract:
- Objective Toexplore the clinical characteristics of hematologic malignancies complicated by acute abdomen in children and establish its standardized management protocols.Methods From January 2010 to June 2024,retrospective analysis was conducted for the relevant clinical data of 40 children hospitalized with hematological malignancies complicated by acute abdomen.General patient profiles,type of primary disease,clinical manifestations and types of acute abdomen,management approaches and treatment outcomes were explored.Results There were 35 boys and 5 girls with a median age of 5.3(1.7-14) year.The major types of hematologic malignancies were acute lymphoblastic leukemia (n=20,50.0%) and acute myeloid leukemia (n=9,22.5%).The predominant clinical manifestations of acute abdomen were localized right lower quadrant pain (n=30,75.0%),fever (n=17,42.5%) and nausea/vomiting (n=15,37.5%).Acute appendicitis (including appendiceal abscess) (62.5%) and intestinal obstruction (22.5%) were the most common types.Based upon clinical status,23 children (57.5%) underwent emergency surgery,4 cases (10.0%) received ultrasound-guided abdominal paracentesis and drainage and the remainders (32.5%) were treated conservatively.In surgery group,cure rate for acute abdomen was 91.3%(21/23) with 2 in-hospital deaths (8.7%).In drainage group,all 4 cases had drains removed within 2 weeks post-procedure with a complete resolution of acute abdomen symptoms.All 13 cases in conservative treatment group were cured after anti-infective and symptomatic regimens.Conclusion For children with hematologic malignancies,a proper management of acute abdomen is rather complex so that a multidisciplinary approach is required.Complete intestinal obstruction and gastrointestinal perforation necessitate prompt surgical interventions while localized appendicitis and intra-abdominal abscesses may be managed with ultrasound-guided percutaneous abdominal drainage or intravenous antibiotics.
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备注/Memo
收稿日期:2024-12-12。
通讯作者:余克驰,Email:yukechicom@126.com