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[儿童肿瘤和恶性血液病中的心包积液。12例研究及发病机制探讨]

[Pericardial effusion in neoplasms and malignant hemopathies in children. Study of 12 cases and pathogenetic considerations].

作者信息

Balducci G, Santoro N, Caliandro P

机构信息

Istituto di Pediatria Clinica e Preventiva dell'Università di Bari, Italia.

出版信息

Pediatr Med Chir. 1987 Mar-Apr;9(2):143-7.

PMID:2821517
Abstract

Pericardial effusion (P.E.) has been described during the course of malignant neoplasms and leukemia, but in children its frequency is not well-known. It is possible by echocardiography to identify very small P.E. M-mode echocardiograms were performed for periodic evaluation of the patients treated by antraciclinic drugs and when P.E. was suspected by the physical examination, chest roentgenogram and electrocardiographic data. A total of 265 echocardiograms were performed in 210 children with malignant neoplasms and leukemia from 1981 to 1985 and 12 cases (5.7%) of P.E. were identified: 7 affected by acute lymphatic leukemia (ALL), 3 Rhabdomyosarcoma, 1 by Wilm's tumor and 1 by Ewing's sarcoma. In all patients was carried out and Ecg, and a chest roentgenogram was performed to evaluate cardiac shadow. Hemoglobin, serum protein and VES values were evaluated to control, respectively, anemia, dysprotidemia and flogistic condition. Pericardiocentesis was played when clinical findings indeed. P.E. was identified in 6 out all cases, 4 affected by ALL and 2 by Rhabdomyosarcoma, during the first clinical approach. Two cases, both affected by ALL, showed large P.E., x-ray enlarged cardiac shadow and typical electrocardiographic findings. The disappearance of the P.E., resulted few days after the beginnings of antiblastic therapy. Four cases were in maintenance therapy: 2 affected by ALL, 1 Ewing's sarcoma and 1 by Rhabdomyosarcoma. The last two showed very large P.E. and pericardiocentesis was necessary: only in patient with rhabdomyosarcoma fluid containing malignant cells was yielded, and reproducing itself one day after.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

心包积液(P.E.)在恶性肿瘤和白血病病程中已有报道,但在儿童中其发生率尚不清楚。通过超声心动图能够识别非常少量的心包积液。对接受蒽环类药物治疗的患者进行定期评估以及当体格检查、胸部X线片和心电图数据提示可疑心包积液时,会进行M型超声心动图检查。1981年至1985年期间,对210例患有恶性肿瘤和白血病的儿童共进行了265次超声心动图检查,其中12例(5.7%)被确诊为心包积液:7例为急性淋巴细胞白血病(ALL),3例为横纹肌肉瘤,1例为肾母细胞瘤,1例为尤因肉瘤。对所有患者均进行了心电图检查,并拍摄胸部X线片以评估心脏阴影。评估血红蛋白、血清蛋白和血沉值以分别控制贫血、蛋白血症和炎症状态。当临床检查确诊时进行心包穿刺术。在首次临床检查时,6例患者被确诊为心包积液,4例为ALL,2例为横纹肌肉瘤。2例均为ALL的患者表现为大量心包积液、X线显示心脏阴影增大及典型的心电图表现。心包积液在抗白血病治疗开始几天后消失。4例处于维持治疗阶段:2例为ALL,1例为尤因肉瘤,1例为横纹肌肉瘤。后两例显示大量心包积液,需要进行心包穿刺术:仅横纹肌肉瘤患者抽出的液体中含有恶性细胞,且一天后复发。(摘要截断于250字)

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