Büyükaşik Y, Ozcebe O I, Sayinalp N, Haznedaroğlu I C, Altundağ O O, Ozdemir O, Dündar S
Department of Hematology, Hacettepe University Medical School, Ankara, Turkey.
Dis Colon Rectum. 1998 Jan;41(1):81-5. doi: 10.1007/BF02236900.
This study was performed to evaluate relations among neutrophil count (including its course), type of lesion, treatment, and prognosis in patients with leukemia and perianal infection.
Medical records of patients with acute and chronic leukemia who were followed during the last five years were reviewed retrospectively.
The incidence of perianal infections was found to be 7.3 percent in 259 patients with acute leukemia. Only 1 of 108 patients with chronic leukemia suffered from this problem. Twenty percent of all patients with this complication died as a result of sepsis. Perianal abscess was the sole and obligatory indication for surgical treatment in our patients. There were ten patients in each treatment group. The operative group had better results (9 cures, 1 complication vs. 3 cures, 7 complications). However, median neutrophil count at diagnosis was notably higher in the operative group 1,280/mm3 vs. 96/mm3; P = 0.075). Also, significantly more frequent abscess formations and, consequently, operative treatments were performed in patients with a period of normal neutrophil counts during the infection compared with continuously neutropenic patients (9 operative, 4 nonoperative vs. 1 operative, 6 nonoperative; P = 0.057). Ten cures, three complications vs. two cures, five complications (3 mortalities) were present in patients with and without normal neutrophil counts, respectively (P = 0.062). When only severely neutropenic patients were considered, four patients in the surgery group had normal neutrophil counts before or shortly after surgery. However, only two of eight patients with perianal cellulitis had normal counts during full-course infection (P = 0.06).
The course of the neutrophil count during infection was an important factor affecting the perianal lesion, and indirectly, choice of treatment and prognosis. A period of normal counts during infection usually led to well bordered and fluctuant lesions, and the prognosis was acceptable with operative treatment. However, continuously neutropenic patients developed nonfluctuating indurations. We found disappointing results with nonoperative treatment of such patients. In all studies, regarding treatment of perianal infections in neutropenic patients, the course of the neutrophil count and indications for surgery should be clarified to get reliable results.
本研究旨在评估白血病合并肛周感染患者的中性粒细胞计数（包括其变化过程）、病变类型、治疗方法及预后之间的关系。
回顾性分析过去五年中随访的急慢性白血病患者的病历。
259例急性白血病患者中肛周感染的发生率为7.3%。108例慢性白血病患者中仅有1例出现此问题。所有发生该并发症的患者中有20%死于败血症。肛周脓肿是我们患者手术治疗的唯一且必要指征。每个治疗组有10例患者。手术组效果更好（9例治愈，1例并发症 vs. 3例治愈，7例并发症）。然而，手术组诊断时的中性粒细胞计数中位数显著更高（1280/mm³ 对比 96/mm³；P = 0.075）。此外，与持续中性粒细胞减少的患者相比，感染期间中性粒细胞计数有正常阶段的患者脓肿形成明显更频繁，因此接受手术治疗的也更多（9例手术，4例非手术 vs. 1例手术，6例非手术；P = 0.057）。中性粒细胞计数正常和不正常的患者分别有10例治愈，3例并发症 vs. 2例治愈，5例并发症（3例死亡）（P = 0.062）。仅考虑严重中性粒细胞减少的患者时，手术组有4例患者在手术前或手术后不久中性粒细胞计数恢复正常。然而，8例肛周蜂窝织炎患者中只有2例在整个感染过程中计数正常（P = 0.06）。
感染期间中性粒细胞计数的变化过程是影响肛周病变的重要因素，间接影响治疗选择和预后。感染期间中性粒细胞计数有正常阶段通常会导致边界清晰且有波动感的病变，手术治疗预后良好。然而，持续中性粒细胞减少的患者会出现无波动感的硬结。我们发现此类患者非手术治疗效果不佳。在所有研究中，对于中性粒细胞减少患者肛周感染的治疗，应明确中性粒细胞计数的变化过程及手术指征以获得可靠结果。
