Grewal H, Guillem J G, Quan S H, Enker W E, Cohen A M
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Dis Colon Rectum. 1994 Nov;37(11):1095-9. doi: 10.1007/BF02049810.
This study was designed to evaluate the spectrum, clinical presentation, management, and outcome of anorectal disease in neutropenic leukemic patients and to compare operative and nonoperative management in neutropenic leukemic patients.
A retrospective review of hospital records was performed.
One hundred fifty-one of 2,618 (5.8 percent) patients hospitalized with leukemia had concomitant symptomatic anorectal disease. Data from 81 patients were available for analysis. Fifty-two (64 percent) were treated nonoperatively and 29 (36 percent) underwent operative treatment. Fifty-seven (70.4 percent) had absolute neutrophil counts < 1,000/mm3, and 54 (66.7 percent) were severely neutropenic (absolute neutrophil count < 500/mm3). Management and outcomes of 54 severely neutropenic patients were analyzed. In 20 patients who underwent surgery there were 4 deaths (20 percent) and 4 recurrences (20 percent), whereas in 34 patients managed nonoperatively there were 6 deaths (18 percent) and 4 recurrences (12 percent) (P > 0.05).
Symptomatic anorectal disease afflicted 5.8 percent of hospitalized leukemic patients. In these patients, anorectal sepsis was a major source of mortality. Our data suggest that anorectal abscesses in neutropenic leukemic patients may be safely drained. Because we did not observe excessive morbidity or mortality (20 percent vs. 18 percent) in the operated neutropenic leukemics as compared with the nonoperated patients, selected neutropenic leukemic patients should not be denied anorectal surgery when otherwise indicated.
本研究旨在评估中性粒细胞减少的白血病患者肛肠疾病的范围、临床表现、治疗及预后，并比较中性粒细胞减少的白血病患者手术治疗与非手术治疗的效果。
对医院记录进行回顾性分析。
2618例住院白血病患者中有151例（5.8%）伴有有症状的肛肠疾病。81例患者的数据可供分析。52例（64%）接受非手术治疗，29例（36%）接受手术治疗。57例（70.4%）的绝对中性粒细胞计数<1000/mm³，54例（66.7%）为严重中性粒细胞减少（绝对中性粒细胞计数<500/mm³）。分析了54例严重中性粒细胞减少患者的治疗及预后情况。20例接受手术的患者中有4例死亡（20%），4例复发（20%）；而34例接受非手术治疗的患者中有6例死亡（18%），4例复发（12%）（P>0.05）。
有症状的肛肠疾病折磨着5.8%的住院白血病患者。在这些患者中，肛肠败血症是主要死亡原因。我们的数据表明，中性粒细胞减少的白血病患者的肛肠脓肿可安全引流。因为与未手术的患者相比，我们未观察到手术治疗的中性粒细胞减少的白血病患者有过高的发病率或死亡率（20%对18%），所以在有手术指征时，不应拒绝为选定的中性粒细胞减少的白血病患者进行肛肠手术。
