以帽状腱膜下血肿为首发表现的慢性髓系白血病一例并文献复习  

Subgaleal hematoma as the first presentation of chronic myeloid leukemia:one case report and literature review

作　　者：石瑞[1] 张婕 梁弘正[1] 杨林花[1] 杨青[1] 王开月 葛晓燕 Shi Rui;Zhang Jie;Liang Hongzheng;Yang Linhua;Yang Qing;Wang Kaiyue;Ge Xiaoyan(Department of Hematology,The Second Hospital of Shanxi Medical University,Taiyuan 030001,China;不详)

机构地区：[1]山西医科大学第二医院血液科,太原030001 [2]山西医科大学第一医院消化内科,太原030001

出　　处：《新医学》2022年第6期448-452,共5页Journal of New Medicine

摘　　要：目的提高临床医师对以帽状腱膜下巨大血肿合并眶内血肿为首发表现的慢性髓系白血病慢性期(CMLCP)的认识水平。方法报道1例以帽状腱膜下巨大血肿合并眶内血肿为首发表现的CML患者的诊疗情况,并以“帽状腱膜下血肿”“慢性髓系白血病”(中英文)为检索词,对PubMed、万方数据知识服务平台、维普中文科技期刊数据库、中国生物医学文献服务系统(SinoMed)、CNKI进行检索,对检索到的相关文献进行复习。结果该例患者为14岁男性,头颅MRI示帽状腱膜下巨大血肿合并眶内血肿,经骨髓象分析诊断为CML-CP,于超声引导下行头皮血肿穿刺抽液术并加压包扎,同时予白细胞分离单采术、羟基脲、阿糖胞苷、酪氨酸激酶抑制剂伊马替尼等治疗后好转,定期随访2年,病情稳定,生命质量尚可。检索文献后收集到2例以帽状腱膜下血肿为首发表现的CML病例,1例头颅CT检查未见异常,1例头颅CT检查提示帽状腱膜下血肿;1例行头皮血肿穿刺抽液术并加压包扎,1例行帽状腱膜下血肿切开引流术,术后情况均良好。结论对于帽状腱膜下血肿合并眶内血肿的CML-CP患者应尽早处理血肿,同时予化学治疗、白细胞分离单采术治疗等,并应尽早给予酪氨酸激酶抑制剂治疗以助其获得良好的预后。Objective To deepen the understanding of clinicians for giant subgaleal hematoma complicated with intraorbital hematoma as the first presentation of chronic myeloid leukemia in chronic phase(CML-CP).Methods The diagnosis and treatment of one case of giant subgaleal hematoma complicated with intraorbital hematoma as the first presentation of CML were reported.Literature review was conducted by using the keywords of subgaleal hematoma and chronic myeloid leukemia in English and Chinese from PubMed,Wanfang Data,Chongqing VIP,SinoMed and CNKI.Results The male patient was aged 14 years old.Skull MRI showed subgaleal hematoma complicated with intraorbital hematoma.He was diagnosed with CML-CP by myelogram analysis.He received ultrasound-guided hematoma puncture with pressure dressing,given with leukapheresis,hydroxyurea,cytarabine and imatinib,a tyrosine kinase inhibitor.During 2-year follow-up,he obtained stable condition and normal quality of life.Two cases of CML presenting with subgaleal hematoma as the initial manifestation were retrieved.One case received cranial CT scan and found no abnormality,and CT scan of the other case prompted subgaleal hematoma;one case underwent hematoma puncture combined with pressure dressing,and the other case received incision and drainage of subgaleal hematoma.Fair clinical prognosis was achieved in two cases.Conclusions CML-CP patients presenting with giant subgaleal hematoma complicated with intraorbital hematoma should promptly receive hematoma puncture in combination with chemotherapy and leukapheresis,etc.In addition,tyrosine kinase inhibitor should be promptly given to enhance clinical prognosis.

关 键 词：慢性髓系白血病 帽状腱膜下血肿 眶内血肿 

分 类 号：R733.72[医药卫生—肿瘤]