恶性血液病中急腹症手术治疗的探讨

AN APPROACH TO OPERATIVE TREATMENT FOR ACUTE ABDOMEN COMPLICATED BY MALIGNANT HEMOPATHY

为探讨恶性血液病并发急腹症时的手术治疗问题，对１４例患者的资料进行分析。原发病有急性白血病、非霍奇金淋巴瘤、多发性骨髓瘤、恶性组织细胞病及骨髓增生异常综合征并难治性贫血，其中１３例处于进展期。并发症为急性阑尾炎、急性胰腺炎、急性胆囊炎、小肠穿孔继发腹膜炎、小肠低位梗阻、原发性腹膜炎及回盲肠综合征。急腹症的类型与原发病及化疗有关，８例采取手术治疗，术后诊断符合率为６２．５％，病理检查仅有２例见肿瘤细胞浸润，死于术后并发症者２例。提示脏器浸润、术前腹痛时间及血象变化是影响手术时机选择和效果的主要因素。

The experience of operative treatment in 14 cases of acute abdomen complicated by malignant hemopathy was reported. Primary diseases consisted of AL, NHL, MM, MH and MDS RA, 13 cases of them were at progressing stage. The acute abdominal conditions included acute appendicitis, acute pancreatitis, acute cholecystitis, peritonitis secondary to intestinal perforation, intestinal obstruction, primary peritonitis and ileocecal syndrome. The type of acute abdomen was related with primary desease and chemotherapy. 8 cases were operated and 2 of them died of complications after operation. Biopsy of excised tissue showed tumor cells in 2 cases. The rate of correllation between preoper active and postoperative diagnosis was 62.5%. These findings suggest that malignant infiltration in the viscera, duration of abdominal pain before operation and the change of blood picture are the major factors for determining operative indication and the postoperative prognosis.