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題 名 | 白血病合併顏面嚴重血腫與壞死性筋膜炎--病例報告=Leukemia Combined with Severe Hematoma and Facial Necrotizing Fasciitis--A Case Report |
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作 者 | 陳元武; 張燕清; 錢新南; | 書刊名 | 中華民國口腔顎面外科學會雜誌 |
卷 期 | 12:2 2001.09[民90.09] |
頁 次 | 頁111-120 |
分類號 | 416.95 |
關鍵詞 | 蜂窩組織炎; 急性骨髓性白血病; 壞死性筋膜炎; Cellulites; Acute myelitic leukemia; Necrotizing fasciitis; |
語 文 | 中文(Chinese) |
中文摘要 | 白血病在口腔經常導致許多併發症,譬如凝血異常及傷口感染等問題,在處置上往往面臨不等程度的挑戰。而壞死性筋膜炎是一種侵犯皮下組織及筋膜之快達進行細菌性壞死病症,患者經常伴隨有其他全身性疾病,其中以糖尿病患最常見,動脈硬化血管性疾病次之。因白血病導致免疫力降低而造成顏面的壞死性筋膜炎則較罕見。 本病例為一12歲男童,因不明原因的發燒住院,檢查診斷為急性骨髓性白血病 (AML) M1型。經誘導性化療後白血球僅存300/mm3;血小板剩20000/ mm3,之後因嘔吐、水瀉、牙齦出血等化療併發症停藥。輸血及支持性治療後十天,因菌血症及伺機性感染造成雙側上顎蜂窩性組織炎,實施雙側上顎前庭區切開引流膿液後,疑似急性腎衰竭 (acute renal failure) 和敗血性休克 (septic shock) 轉入小兒加護中心。狀況控制穩定後,在原引流區沖洗換敷料 及局部清創以確定引流暢通;當晚,在引流區傷口突然大量出血,面部劇烈腫脹,且張口受限,消腫後面部有焦痂壞死現象,疑似壞死性筋膜炎;立即以手術清創引流,發現在左側上顎前庭區至在下顎頷下間隙處為一相通的空間,約有100毫升之血塊及壞死組織充斥其間,細菌培養發現危鏈球菌及綠膿桿菌。手術之後凝血狀況仍未穩定,再度發生腸道出血,引發低血容休克而有輕度的中風,再入小兒加護中心觀察;且兩度因休克導致腸道部分壞死及出血,經手術切除壞死組織並止血。臉部黑色焦痂因缺血逐漸與周圍組織分離,傷口復原隨著免疫和凝血狀況起伏不定,前後為程歷經116日,直到白血病及凝血問題控制良好,面部傷口才經清創和換敷料而逐漸癒合,出院改為門診治療,本病例殊屬罕見和危險,特提出報告。 |
英文摘要 | Facial necrotizing fasciitis due to leukemia is rare to seen. Necrotizing fasciitis is an infectious disease with characteristics of rapid process of subcutaneous tissue and fascia damage. It usually accompanied with other systemic disease, such as diabetes mellitus and arteriosclerosis. Oral coagulopathy and infection were usually found in leukemia which had variant degree of challenge to treat. We have reported a case of leukemia combined with severe hematoma and facial necrotizing fasciitis. This case was rare and critical, because of the severe complication, difficult to control and consulted other specialist. A 12-year-old boy, who admittd to our hospital suffered unknown fever for two-week. Type I acute myelitic leukemia was diagnosed by bone marrow biopsy. Chemotherapy was postponed due to the complications of vomiting, diarrhea and gingival bleeding. In ten days later, althought the patient had transfusion and supporting treatment, he got opportunity infection at gingiva. Then he caused cellulites over bilateral maxilla. Oral -maxillofacial surgeon was consulted emergently for incision and drainage over the bilateral maxilla vestibule. The patient was transferred to intensive care unit under the impression of acute renal failure and septic shock. Because the drainage wound had active bleeding suddenly; the puffy face and trismus were encountered. Until swelling was subsided; the necrotic crust was noted at the buccal region of the left face. The necrotizing fasciitis was therefore suspected. Streptococcus viridian and Psuedomonas auriginosa were revealed in bacterial culture. After debridement and supporting treatment, the patient's facial conditions were healed. |
本系統中英文摘要資訊取自各篇刊載內容。