Gondal Ghous, Johnson Egil, Paulsen Vemund, Hasan Banitalebi
Gastrokirurgisk avdeling, Oslo universitetssykehus, Ullevål 0407, Oslo, Norway.
Tidsskr Nor Laegeforen. 2010 Jan 28;130(2):143-5. doi: 10.4045/tidsskr.08.0089.
Neutropenic enterocolitis is a life-threatening complication that usually occurs in connection with chemotherapy for acute leukemias. Our experience with diagnosis and treatment of these patients is presented.
Medical records from patients treated for neutropenic enterocolitis at Ullevaal University Hospital in the period 2000-2008 were retrospectively reviewed.
16 patients with median age 33 years were treated for neutropenic enterocolitis. Induction chemotherapy was given for acute myelogenic (n = 9) or lymphatic (n = 4) leukemia, myelomatosis (n = 2) or lymphoma (n = 1). The patients developed aplasia five days (median) after start of chemotherapy. All patients were first treated conservatively with broad-spectrum antibiotics, fluids and electrolyte supplementation; nine of them recovered without complications. Four underwent surgery for perforation or ileus and these had the longest period with aplasia (median 31 days). Surgery for perforation is mainly limited resection and construction of ileostomy reservoirs (one or two). Three patients died. These were only treated conservatively; aplasia occurred quicker in these patients (after median two days) and they had the largest number of affected bowel segments (median nine).
Neutropenic enterocolitis is a heterogeneous condition and the treatment is mainly conservative. Surgical intervention is mandatory in patients with free intraabdominal air, ileus and intractable intestinal bleeding. The prognosis seems to worsen when aplasia develops after a short time and when there is a large number of affected bowel segments.
中性粒细胞减少性小肠结肠炎是一种危及生命的并发症，通常与急性白血病的化疗相关。本文介绍了我们对这些患者的诊断和治疗经验。
回顾性分析了2000年至2008年期间在乌勒瓦尔大学医院接受中性粒细胞减少性小肠结肠炎治疗的患者的病历。
16例中位年龄为33岁的患者接受了中性粒细胞减少性小肠结肠炎的治疗。诱导化疗用于急性髓性白血病（n = 9）或淋巴细胞白血病（n = 4）、骨髓瘤（n = 2）或淋巴瘤（n = 1）。患者在化疗开始后5天（中位时间）出现再生障碍性贫血。所有患者首先接受广谱抗生素、液体和电解质补充的保守治疗；其中9例无并发症康复。4例因穿孔或肠梗阻接受手术，这些患者再生障碍性贫血持续时间最长（中位时间31天）。穿孔手术主要是有限切除和回肠造口贮袋（一个或两个）的构建。3例患者死亡。这些患者仅接受了保守治疗；这些患者再生障碍性贫血出现更快（中位时间为两天后），且受累肠段数量最多（中位数量为9个）。
中性粒细胞减少性小肠结肠炎是一种异质性疾病，治疗主要为保守治疗。对于有腹腔内游离气体、肠梗阻和难治性肠道出血的患者，必须进行手术干预。当再生障碍性贫血在短时间内发生且受累肠段数量较多时，预后似乎会恶化。
