免疫功能低下儿童肛周脓毒症伴坏疽性脓皮病的结肠造口术
Colostomy for Perianal Sepsis With Ecthyma Gangrenosum in Immunocompromised Children.
作者信息
Vuille-dit-Bille Raphael N, Berger Christoph, Meuli Martin, Grotzer Michael A
机构信息
*Department of Pediatric Surgery ‡Division of Infectious Diseases and Hospital Epidemiology §Division of Oncology †Children's Research Centre, University Children's Hospital of Zurich, Zurich, Switzerland.
出版信息
J Pediatr Hematol Oncol. 2016 Jan;38(1):53-7. doi: 10.1097/MPH.0000000000000324.
BACKGROUND
Perianal sepsis with ecthyma gangrenosum is a severe and potentially mutilating complication in immunocompromised children. Therapies include antimicrobial treatment, incision and drainage, generous tissue debridement, and skin transplantation.
PROCEDURE
We describe 3 children with acute lymphoblastic leukemia having sepsis with Pseudomonas aeruginosa in febrile neutropenia and severe perianal infections treated relatively early with a protective colostomy. Indications for colostomy were nonhealing wounds, and ceaseless pain.
RESULTS
All patients showed a rapid reduction of pain. Complete wound healing was seen in 2 patients, and considerable pain reduction and increased quality of life were seen in a third patient during palliative care.
CONCLUSIONS
These results suggest that a protective colostomy should be considered early in the management of immunocompromised children with ecthyma gangrenosum.
背景
伴有坏疽性脓皮病的肛周脓毒症是免疫功能低下儿童的一种严重且可能致残的并发症。治疗方法包括抗菌治疗、切开引流、广泛的组织清创和皮肤移植。
操作
我们描述了3例急性淋巴细胞白血病患儿，他们在发热性中性粒细胞减少症期间发生了铜绿假单胞菌脓毒症，并伴有严重的肛周感染，相对早期接受了保护性结肠造口术治疗。结肠造口术的指征为伤口不愈合和持续疼痛。
结果
所有患者疼痛均迅速减轻。2例患者伤口完全愈合，第3例患者在姑息治疗期间疼痛显著减轻且生活质量提高。
结论
这些结果表明，对于患有坏疽性脓皮病的免疫功能低下儿童，在治疗早期应考虑行保护性结肠造口术。
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