Sanders J E
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Radiother Oncol. 1990;18 Suppl 1:82-7. doi: 10.1016/0167-8140(90)90181-u.
Bone marrow transplantation is a life-saving procedure for an increasing number of children and young adults. As greater number of patients continue to receive this procedure and are cured of their underlying hematologic disorder, greater attention must be given to the delayed effects, especially those which do not appear until years after the transplant procedure. Children who are cured of their underlying disease continue to visit the hematologist/oncologist, but with decreasing frequency as time increases following the curative therapy, and at the same time increase the relative frequency of visits to their pediatrician. Thus, it is imperative that the primary care pediatrician be aware of the details of the patient's previous medical history, especially of chemotherapy and irradiation therapy which may have been given, in order to anticipate the delayed effects. Early diagnosis of thyroid and GH deficiencies with institution of appropriate hormone therapy may prevent subsequent development of thyroid malignancy and may improve the child's growth and development. Recognition of cataracts and dry eye syndrome is necessary to prevent visual difficulties. Careful oral examination and attention to the child's general neurological presentation and inquiry regarding school performance is important in recognising dental difficulties, learning difficulties and early recognition of development of tumors of the head and neck. Attention to details, early recognition of problems and early therapy of the problems is needed to improve the quality of life for these unique patients.
骨髓移植对于越来越多的儿童和年轻人来说是一种挽救生命的治疗方法。随着越来越多的患者继续接受这种治疗并治愈其潜在的血液系统疾病，必须更加关注延迟效应，尤其是那些直到移植手术后数年才出现的效应。治愈潜在疾病的儿童会继续去血液科医生/肿瘤科医生那里就诊，但随着治愈性治疗后时间的增加，就诊频率会逐渐降低，同时去儿科医生处就诊的相对频率会增加。因此，至关重要的是，基层医疗儿科医生要了解患者既往病史的详细情况，尤其是可能接受过的化疗和放疗情况，以便预测延迟效应。早期诊断甲状腺和生长激素缺乏并进行适当的激素治疗，可能会预防随后甲状腺恶性肿瘤的发生，并可能改善儿童的生长发育。识别白内障和干眼综合征对于预防视力问题很有必要。仔细的口腔检查、关注儿童的一般神经学表现以及询问学习情况，对于识别牙齿问题、学习困难以及早期发现头颈部肿瘤的发生很重要。关注细节、早期识别问题并对问题进行早期治疗，对于提高这些特殊患者的生活质量是必要的。
