儿童急性白血病并发急性阑尾炎的临床特点和诊治分析

The clinical characteristic and treatment of acute leukemia combined with acute appendicitis in children

目的:分析儿童急性白血病(acute leukemia,AL)并发急性阑尾炎的临床特点和诊治策略,为临床优化诊疗方案提供参考。方法:对2015年1月至2022年6月我中心血液肿瘤科住院的急性白血病治疗过程中并发急性阑尾炎的6例患儿临床资料进行回顾性分析。该6例患儿均采用中国儿童肿瘤协作组CCCG-ALL-2015方案联合化疗。通过分析总结患儿的临床表现、发生急性阑尾炎时所处的治疗阶段、超声特点及治疗手段,对比患儿的治疗效果及其转归。结果:收集的6例患儿,根据出现急性阑尾炎的时间依次编号为例1-6,均为男性,年龄范围2~12岁,中位年龄6岁;急性B淋巴细胞白血病5例(B-ALL),急性混合表型白血病(T淋系+髓系表型)1例,急性阑尾炎可出现在化疗的不同阶段,初始联合化疗开始45天内发病的4例,化疗间期1例,再诱导阶段1例。6例患儿主要表现为发热、右下腹痛、腹胀、呕吐,腹部超声诊断急性阑尾炎。1例接受单纯内科治疗,2例诊断后立即行腹腔镜手术治疗,3例内科保守治疗无效后行腹腔镜治疗。6例患儿阑尾炎均得以治愈,其中5例推迟化疗进程。结论:儿童AL并发急性阑尾炎多发生在ALL,并在早期联合化疗阶段发生,临床应早期识别诊断并选择最优的治疗方案,早期腹腔镜手术安全有效,联合内科围手术期的支持治疗可使患儿最大获益。

Objective:To analyze the clinical characteristics and treatment of acute appendicitis in children with acute leukemia(AL),and to provide reference for clinical optimization of diagnosis and treatment.Methods:Clinical data of 6 children with AL complicated with acute appendicitis from January 2015 to June 2022 were analyzed retrospectively.All patients followed the China Children's Cancer Group CCCG-ALL-2015 combined regimen.The clinical manifestations,treatment stage,ultrasonic characteristics and treatment methods of patients were analyzed.Finally,the therapeutic effects and outcomes of the patients were compared.Results:According to the time of diagnosis of acute appendicitis,6 cases were numbered as case 1 to 6.They were all male,aged between 2~12 years old,with a median age of 6 years.Five patients had type B acute lymphoblastic leukemia(B-ALL)and 1 had mixed phenotypic acute leukemia (T lymphocyte and myeloid phenotype).Acute appendicitis can occur at different stages of chemotherapy,including 4 cases within 45 days after the initial combined chemotherapy,1 case at the interval of chemotherapy,and 1 case at the re-induced stage.The main manifestations of 6 children were fever,right lower abdominal pain,abdominal distension and vomiting,and acute appendicitis was diagnosed by abdominal ultrasound.One patient received simple medical treatment,2 patients received laparoscopic surgery immediately after diagnosis,and 3 patients received laparoscopic treatment after medical conservative treatment failed.Six children with appendicitis were cured,and 5 of them delayed the process of chemotherapy. Conclusion: Acute appendicitis in children with AL often occurs in ALL and occurs in the early stages of combined chemotherapy.Early diagnosis and optimal treatment is important.Early laparoscopic surgery is safe and effective,and combined with supportive treatment in the perioperative period of internal medicine can maximize the benefits of children.