Cohen J S, Paz I B, O'Donnell M R, Ellenhorn J D
Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California 91010, USA.
Dis Colon Rectum. 1996 Sep;39(9):981-5. doi: 10.1007/BF02054685.
Bone marrow transplantation (BMT) is often associated with profound neutropenia. Allogeneic transplant recipients also have defects in both humoral and cellular immunity and thus are subject to increased risk of serious, often life-threatening, infection even beyond the period of granulocyte recovery. The current study was undertaken to evaluate patients who required operative intervention for perianal sepsis following BMT.
The bone marrow transplant database at a single institution was used to identify all patients diagnosed with perianal infections after autologous or allogeneic BMT. Charts were reviewed in a retrospective manner.
Over a ten-year period ending in November 1993, 963 BMT were performed at the City of Hope National Medical Center. Twenty-four patients were diagnosed with perianal infections following their transplants. Fifteen patients did not have purulent collections requiring drainage and were treated with antibiotics and supportive measures alone. Nine patients (37.5 percent) required surgical intervention between 10 and 380 days following transplantation. At the time of surgical intervention, seven patients had purulent collections and two patients had acute and chronic inflammation, tissue necrosis, and fibrosis. Of the two patients with an absolute neutrophil count less than 1,000, a purulent collection was found in one of the patients. Cultures taken from perianal abscesses were almost all polymicrobial, and the most common organisms were Escherichia coli, Bacteroides, Enterococcus, and Klebsiella. For those patients undergoing surgical intervention, mean time to complete wound closure by secondary intention was 37.6 days; five patients healed in less than 15 days, two patients healed at 93 and 114 days, and two patients had persistent, open wounds at time of death, which was unrelated to their perianal disease. Five patients were receiving systemic steroids at time of surgical intervention; this did not appear to affect time to wound healing.
Perianal infections are a rare complication of BMT. Majority of these infections are polymicrobial, and organisms isolated are similar to those seen in the perianal infections of nonimmunosuppressed patients. Despite steroid use, granulocytopenia does not exclude the possible presence of purulent collections, and clinical examination should guide the decision for surgical drainage. In general, perianal wound healing is not prolonged in BMT patients.
骨髓移植（BMT）常伴有严重的中性粒细胞减少。同种异体移植受者在体液免疫和细胞免疫方面也存在缺陷，因此即使在粒细胞恢复之后，他们仍面临发生严重感染（常危及生命）的风险增加。本研究旨在评估骨髓移植后因肛周脓毒症而需要进行手术干预的患者。
利用单一机构的骨髓移植数据库来确定所有在自体或同种异体骨髓移植后被诊断为肛周感染的患者。以回顾性方式查阅病历。
截至1993年11月的十年间，希望之城国家医疗中心共进行了963例骨髓移植。24例患者在移植后被诊断为肛周感染。15例患者没有需要引流的脓性积液，仅接受了抗生素治疗和支持性措施。9例患者（37.5%）在移植后10至380天需要手术干预。在进行手术干预时，7例患者有脓性积液，2例患者有急性和慢性炎症、组织坏死及纤维化。在2例绝对中性粒细胞计数低于1000的患者中，有1例发现有脓性积液。从肛周脓肿采集的培养物几乎均为多微生物感染，最常见的微生物为大肠杆菌、拟杆菌、肠球菌和克雷伯菌。对于那些接受手术干预的患者，通过二期愈合实现伤口完全闭合的平均时间为37.6天；5例患者在不到15天内愈合，2例患者分别在93天和114天愈合，2例患者在死亡时仍有持续的开放性伤口，死亡与肛周疾病无关。5例患者在手术干预时正在接受全身性类固醇治疗；这似乎并未影响伤口愈合时间。
肛周感染是骨髓移植的一种罕见并发症。这些感染大多数为多微生物感染，分离出的微生物与非免疫抑制患者肛周感染中所见的微生物相似。尽管使用了类固醇，但粒细胞减少并不排除可能存在脓性积液，临床检查应指导手术引流的决策。一般而言，骨髓移植患者的肛周伤口愈合时间不会延长。
