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題名 | Invasive Aspergillosis Causing Small Bowel Perforation during Induction Chemotherapy for Acute Lymphoblastic Leukemia in Children=兒童急性淋巴性白血病患者於前導性化學治療期間發生由侵襲性麴菌症所造成的小腸穿孔 |
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作者 | 傅玉瑋; 王念陸; 許錦城; 劉希哲; 葉庭吉; 杜奕成; 魏晉弘; | 書刊名 | 臺灣癌症醫學雜誌 |
卷期 | 27:5 2011.10[民100.10] |
頁次 | 頁227-231 |
分類號 | 417.5515 |
關鍵詞 | 麴菌病; 腸道穿孔; 白血病; 化學治療; Aspergillosis; Intestinal perforation; Leukemia; Chemotherapy; |
語文 | 英文(English) |
中文摘要 | 我們報告兩例小兒急性淋巴性白血病患者,皆於接受前導性化學治療期間,發生由侵襲 性麴菌症造成的小腸穿孔。一位十四歲少女以嗜中性白血球低下併發燒為初期表現,在 接受化療後第三十天,發展成大量消化道出血併休克。另一位二歲的男孩,亦患嗜中性 白血球低下併發燒及在第二十一天產生腹膜炎。兩位病患皆接受緊急剖腹探查並發現小腸穿孔,手術將穿孔小腸段切除後行直接吻合腸道。病理檢查下,顯現全壁式壞死和肌 層真菌侵犯。兩位患者術後在重症照顧之下都恢復順利,對於抗黴菌藥物及後續化學治 療都有良好的反應。侵襲性麴菌病發生在腸道相當罕見且危及生命。若嗜中性白血球低 下患者,於化療期間出現胃腸道症狀並發燒時,需高度懷疑侵襲性麴菌症造成腸穿孔。 如果發生腸穿孔,需要及時手術治療。術後持續使用抗黴菌藥物治療可降低死亡率。 |
英文摘要 | We report on two pediatric patients suffering from acute lymphoblastic leukemia with small bowel perforation caused by invasive aspergillosis during their induction course of chemotherapy. A 14-year-old girl presented with neutropenic fever who developed massive gastrointestinal bleeding with shock 30 days after chemotherapy. Another 2-year-old boy had neutropenic fever and peritonitis which developed 21 days after chemotherapy. Both patients underwent urgent laparotomies, and small bowel perforation was found in each child. Segmental resection of the involved intestine with primary anastomosis was performed. Microscopic examination revealed transmural necrosis and fungal invasion of the bowel. The two patients recovered uneventfully under intensive postoperative care, manifesting a good response to anti-fungal agents and further chemotherapies. Invasive intestinal aspergillosis is rare but life threatening, and should be kept in mind when neutropenic patients present with gastrointestinal symptoms and fever during chemotherapy. Prompt surgical intervention is required in case of intestinal perforation whereafter timely postoperative administration of anti-fungal therapy may decrease patient mortality. |
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