Department of Colorectal Surgery, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China.
Medicine (Baltimore). 2024 May 10;103(19):e38082. doi: 10.1097/MD.0000000000038082.
The efficacy of surgical intervention for perianal infection in patients with hematologic malignancies is not well established. Therefore, our study aimed to investigate the clinical efficacy and complications of surgical treatment of perianal infection in patients with hematologic malignancies. This retrospective study included patients with hematological malignancies who were diagnosed with perianal infections and treated at the China Aerospace Science & Industry Corporation 731 Hospital between 2018 and 2022. Patient characteristics, hematological data, surgical intervention, and complications, including recurrence and mortality, were analyzed. This study included 156 patients with leukemia aged 2 months to 71 years who were treated surgically for perianal infection, comprising 94 males and 62 females. Perianal infection included 36 cases of abscesses, 91 anal fistulas, and 29 anal fissures accompanied by infection. A total of 36 patients developed severe complications postoperatively, including 4 patients who died, 6 patients with severe incision bleeding, 18 patients with severe pain, 6 patients with sepsis, 12 patients who needed reoperation, 15 patients with hospitalization for more than 2 weeks, and 3 patients with anal stenosis; none of the patients developed anal incontinence. Additionally, risk factors for postoperative complications of perianal infection in patients with hematologic malignancies include leukopenia, agranulocytosis, thrombocytopenia, depth of abscess and not undergone an MRI. Surgical intervention may improve the prognosis of patients with perianal abscess formation, particularly in patients who show no improvement with medical therapy and those who develop perianal sepsis. Granulocytopenia and thrombocytopenia should be improved before surgery, which can significantly reduce postoperative complications. Although these findings are from a case series without a comparator, they may be of value to physicians because to the best of our knowledge, no randomized or prospective studies have been conducted on the management of perianal infections in patients with hematological malignancies.
外科干预在血液恶性肿瘤患者肛周感染中的疗效尚未得到充分证实。因此，我们的研究旨在探讨外科治疗血液恶性肿瘤患者肛周感染的临床疗效和并发症。这项回顾性研究纳入了 2018 年至 2022 年在中国航天科工集团 731 医院诊断为肛周感染并接受治疗的血液恶性肿瘤患者。分析了患者特征、血液学数据、手术干预以及包括复发和死亡在内的并发症。
本研究纳入了 156 例年龄在 2 个月至 71 岁的白血病男性 94 例，女性 62 例患者接受肛周脓肿切开引流术、肛瘘切除术、肛裂切除术等手术治疗。肛周感染包括脓肿 36 例，肛瘘 91 例，肛裂伴感染 29 例。术后共 36 例患者发生严重并发症，包括死亡 4 例，切口严重出血 6 例，严重疼痛 18 例，脓毒症 6 例，需要再次手术 12 例，住院时间超过 2 周 15 例，肛门狭窄 3 例，无肛门失禁发生。
此外，血液恶性肿瘤患者肛周感染术后并发症的危险因素包括白细胞减少、粒细胞缺乏、血小板减少、脓肿深度和未行 MRI 检查。外科干预可能改善肛周脓肿形成患者的预后，特别是对于药物治疗无效和发生肛周脓肿的患者。术前应改善粒细胞减少和血小板减少，这可显著减少术后并发症。尽管这些发现来自无对照的病例系列研究，但由于据我们所知，尚无关于血液恶性肿瘤患者肛周感染管理的随机或前瞻性研究，因此这些发现可能对医生具有一定价值。
