血液系统恶性疾病并发急腹症手术治疗临床分析

An approach to operative treatment for acute abdomen complicated with malignant hematopathy

目的探讨血液系统恶性疾病并发急腹症时的手术治疗问题。方法对13例患者的临床资料进行回顾性分析。原发病:急性白血病、淋巴瘤、骨髓增生异常综合征伴原始细胞增多。并发症:消化道出血、阑尾炎、胆囊炎胆石症、自发性脾破裂、小肠穿孔、低位小肠急性梗阻、黄体破裂、卵巢畸胎瘤伴蒂扭转。均采取手术治疗,术后予监护、抗感染、支持治疗。结果病理检查7例标本见肿瘤细胞浸润,死亡4例,9例患者术后急腹症疾病获治愈。结论急腹症的类型与原发病及化疗有关,术前患者一般情况、脏器浸润及血象变化是影响手术时机选择和效果的主要因素。合理的手术治疗是挽救患者生命的有效手段。

Objective To investigate the operative indications and prognosis for acute abdomen comphcated with malignant hematopathy. Methods The experience of operative treatment in 13 cases of acute abdomen complicated with malignant hematopathy was analyzed. Primary diseases consisted of acute leukemia,lymphoma,myelodys prdiferative syndrome（MDS）. The acute abdominal conditions included alimentary tract hemorrhage, appendicitis, cholecystitis, cholelithiasis, spontaneous splenic rupture, perforation of intestine, acute obstruction of low - set small intestine, corpus luteum rupture and torsion of pedicle complicated by ovarian teratoma. All the cases were under operation. Intensive postoperative care, nutrition support, anti - infective therapy were taken. Results Histopathological examinations of surgical speci- mens showed tumor cells in 7 cases,4 cases died of comphcations after operation, while diseases causing acute abdomen were cured in 9 cases. Conclusion The type of acute abdomen was related with primary disease and chemotherapy. These findings suggest that general state of health before operation, malignant infiltration in the viscera and the change of blood picture are the major factors for determining operative indication and the postoperative prognosis. Reasonable operation is the effective process to save the patients.