Starnes H F, Moore F D, Mentzer S, Osteen R T, Steele G D, Wilson R E
Cancer. 1986 Feb 1;57(3):616-21. doi: 10.1002/1097-0142(19860201)57:3<616::aid-cncr2820570337>3.0.co;2-4.
A review of 58 patients with malignancies (age range, 14-73 years), who required surgical consultation for acute abdominal pain in the setting of neutropenia (granulocyte count less than 1000/mm3) after chemotherapy was conducted. Ninety percent had fevers greater than 37.8 degrees C, 30% had diarrhea or melena, and 25% had diminished bowel sounds. Five of the 29 patients (17%) with localized pain had surgical intervention; 3 of 29 patients (10%) with generalized pain underwent operations (2 for x-ray findings). All eight of these surgically treated patients survived to leave the hospital. Eighteen of the 29 patients with generalized pain were believed to have a similar syndrome of diarrhea (occasionally heme positive) and diffuse abdominal tenderness (some with peritoneal signs and distension), which was termed "neutropenic enteropathy." Eleven of these 18 patients had their symptoms resolve with antibiotic therapy, aggressive fluid replacement, and a return of their granulocyte count to normal. The other seven died of pneumonia (two), unknown causes (one), and diffuse enterocolitis throughout the intestinal tract (four documented at autopsy). The overall 30-day mortality rate in this series was 34%. Several factors correlated significantly with mortality: hypotension at the onset of pain (80% mortality), bacteremia (63% mortality), and fungemia (100% mortality). Absolute leukocyte count and absolute platelet count did not correlate with mortality. This study reaffirms that patients with neutropenic enteropathy are best treated conservatively. Patients with surgically correctable disease were identified by specific focal findings on examination or x-ray.
对58例恶性肿瘤患者（年龄范围14 - 73岁）进行了回顾性研究，这些患者在化疗后出现中性粒细胞减少（粒细胞计数低于1000/mm³）并因急性腹痛需要外科会诊。90%的患者发热超过37.8摄氏度，30%的患者有腹泻或黑便，25%的患者肠鸣音减弱。29例局部疼痛患者中有5例（17%）接受了手术干预；29例全身疼痛患者中有3例（10%）接受了手术（2例因X线检查结果）。所有这8例接受手术治疗的患者均存活出院。29例全身疼痛患者中有18例被认为患有类似的腹泻综合征（偶尔潜血阳性）和弥漫性腹部压痛（部分有腹膜刺激征和腹胀），被称为“中性粒细胞减少性肠病”。这18例患者中有11例通过抗生素治疗、积极补液以及粒细胞计数恢复正常后症状得到缓解。另外7例死于肺炎（2例）、不明原因（1例）和全肠道弥漫性小肠结肠炎（4例尸检证实）。该系列研究的总体30天死亡率为34%。几个因素与死亡率显著相关：疼痛发作时低血压（死亡率80%）、菌血症（死亡率63%）和真菌血症（死亡率100%）。绝对白细胞计数和绝对血小板计数与死亡率无关。这项研究再次证实，中性粒细胞减少性肠病患者最好采用保守治疗。通过体格检查或X线检查发现的特定局灶性表现来识别具有手术可纠正疾病的患者。
