North J H, Weber T K, Rodriguez-Bigas M A, Meropol N J, Petrelli N J
Division of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
J Am Coll Surg. 1996 Oct;183(4):322-8.
Infectious and noninfectious anorectal complications may occur in patients undergoing therapy for leukemia. Controversy surrounds the treatment of this problem in immunocompromised patients.
A retrospective review of the medical records of 83 patients with acute or chronic leukemia in whom anorectal disease developed during inpatient therapy for leukemia was performed to determine the initial signs and symptoms, treatment, and outcomes.
During a 12-year period, 92 patients with anorectal complications were treated. This series included 25 patients with perirectal abscesses, 22 patients with anal fissures, 18 patients with symptomatic external hemorrhoids, 12 patients with perianal ulcerations, 12 patients with symptomatic internal hemorrhoids, and three patients with fistulas in ano. Overall, 79 (86 percent) of the 92 anorectal complications resolved in 68 of the 83 patients. Increasing periods of neutropenia did not adversely affect the resolution of anorectal disease. Thirteen patients (16 percent) required surgical intervention, most commonly secondary to a perirectal abscess. Incision and drainage was necessary in ten (40 percent) of 25 patients with perirectal abscess, which included five patients with fluctuation and five patients in whom infection failed to respond to medical therapy.
Noninfectious anorectal complications in patients with leukemia respond to nonoperative intervention and rarely progress to a life-threatening infection. Nonoperative intervention in the form of systemic antibiotics and sitz baths is successful in the treatment of infectious anorectal complications. Incision and drainage should be performed when fluctuation is present and in patients whose complications fail to respond to medical therapy.
白血病患者在接受治疗期间可能会出现感染性和非感染性肛肠并发症。免疫功能低下患者该问题的治疗存在争议。
对83例急性或慢性白血病患者的病历进行回顾性分析，这些患者在白血病住院治疗期间出现了肛肠疾病，以确定其初始体征和症状、治疗方法及治疗结果。
在12年期间，共治疗了92例肛肠并发症患者。该系列包括25例直肠周围脓肿患者、22例肛裂患者、18例有症状的外痔患者、12例肛周溃疡患者、12例有症状的内痔患者和3例肛瘘患者。总体而言，92例肛肠并发症中的79例（86%）在83例患者中的68例中得到缓解。中性粒细胞减少期延长并未对肛肠疾病的缓解产生不利影响。13例患者（16%）需要手术干预，最常见的原因是直肠周围脓肿。25例直肠周围脓肿患者中有10例（40%）需要切开引流，其中包括5例有波动感的患者和5例感染对药物治疗无反应的患者。
白血病患者的非感染性肛肠并发症对非手术干预有反应，很少发展为危及生命的感染。全身性抗生素和坐浴形式的非手术干预成功地治疗了感染性肛肠并发症。当出现波动感以及并发症对药物治疗无反应的患者应进行切开引流。
