羟基脲致痛性难愈性溃疡2例

Painful refractory ulcer due to hydroxycarbamide：two cases reports

例1男性，69岁，因慢性粒细胞白血病服用羟基脲1.0 g／d，1年后左足外踝部出现溃疡且迁延不愈达5年。检查见溃疡大小约8 cm ×6 cm，其上附着黄色坏死组织，周围皮肤水肿并出现红斑，触痛明显。给予哌拉西林舒巴坦钠3.0 g静脉滴注，1次／12 h，共10 d。第10、35天分别行清创＋创面负压封闭＋自体皮移植术，但第1次术后14 d和第2次术后10 d均出现皮片坏死，患者放弃治疗。例2男性，80岁，因慢性粒细胞白血病服用羟基脲1.0 g／d，1年后右足跟及左足外踝出现多处溃疡且迁延不愈达1年。检查见溃疡最大者约6 cm ×4 cm，其上附着黄白色坏死组织，无新鲜肉芽，周围皮肤水肿并出现红斑，触痛明显。给予哌拉西林舒巴坦钠3.0 g静脉滴注，1次／12 h，并给予银离子联合交互式敷料外敷，1次／d。24 h后患者创面疼痛减轻；5 d后创面出现新鲜肉芽，坏死组织脱落；15 d 创面出现上皮化；40 d创面基本愈合。2例患者治疗溃疡过程中均按原剂量服用羟基脲。

Patient 1,a 69-year-old male with chronic myelocytic leukemia received hydroxycarbamide 1. 0 g/d. The refractory ulcer developed on his lateral malleolus in left foot one year later and lasted for 5 years. Physical examination showed the ulcerˊs area was 8 cm × 6 cm. The yellow necrotic tissue adhered to the surface of ulcers. The edema,erythema and severe tenderness appeared in surrounding skin of ulcers. He was given an IV infusion of piperacillin sodium and sulbactam sodium 3. 0 g twice daily for 10 days. The patient received an operation of debride ＋vacuum sealing ＋autologous skin graft on day 10 and 35 of hospitalization, respectively. But the necrosis in skin graft appeared on the fourteenth day after the first operation and the tenth days after the second operation,respectively. The patient gave up the treatment and were discharged. Patient 2,an 80-year-old male with chronic myelocytic leukemia received hydroxycarbamide 1. 0 g/d. The refractory ulcers developed on his right and left heels one year later and lasted for one year. Physical examination showed that the maximal ulcerˊs area was 6 cm × 4 cm. There were yellow necrotic tissue adhering to the surface of ulcers without granulation tissue. The edema,erythema and severe tenderness were found in the surrounding skin of ulcers. He was given an IV infusion of piperacillin sodium and sulbactam sodium 3. 0 g twice daily and a combined interactive Ag dressing（ HARTMANN,Germany）on the surface of ulcers once daily. The patient felt the pain decreased 24 hours later. On day 5,new granulation tissue appeared on the surface of a wound, and the necrotic tissue fell off. On day 15,epithelialization appeared on the surface of the wound. On day 40, scar formation on the surface of the wound appeared and the patient was discharged. The two patients continued to take the hydroxycarbamide according to the original dose during the process of treatment of ulcer.