血液系统恶性肿瘤患儿创面流行病学特点与治疗情况分析

朱海; 刘梓钰; 郭春来; 陈琨

doi:10.3760/cma.j.cn501225-20250623-00278

血液系统恶性肿瘤患儿创面流行病学特点与治疗情况分析

doi: 10.3760/cma.j.cn501225-20250623-00278

朱海¹,
刘梓钰¹,
郭春来¹,
陈琨^{1, 2, ,}

1.
北京市顺义区妇幼保健院,北京儿童医院顺义妇儿医院整形美容外科,北京　101399
2.
首都医科大学附属北京儿童医院烧伤整形科,北京　100045

基金项目:

北京高层次创新创业人才支持计划 G20250419

详细信息

通讯作者:
陈琨,Email：chenkun97@126.com

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出版历程
- 收稿日期: 2025-06-23
- 网络出版日期: 2026-11-06

Analysis of epidemiological characteristics and treatment of wounds in pediatric patients with hematologic malignancies

Zhu Hai¹,
Liu Ziyu¹,
Guo Chunlai¹,
Chen Kun^{1, 2
, ,}

1.
Department of Plastic and Reconstructive Surgery, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing 101399, China
2.
Department of Burns and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China

Funds:

Beijing High-level Innovation and Entrepreneurship Talent Support Program G20250419

More Information

Corresponding author: Chen Kun, Email: chenkun97@126.com

摘要

摘要: 目的探讨血液系统恶性肿瘤患儿创面流行病学特点与治疗情况。方法该研究为回顾性病例系列研究。2017年1月—2024年12月,首都医科大学附属北京儿童医院收治20例、北京市顺义区妇幼保健院收治12例符合入选标准的血液系统恶性肿瘤患儿,共41个创面。统计患儿的性别、年龄、血液系统恶性肿瘤类型,创面成因、部位、出现时间、面积、深度、有无肿瘤侵及、合并感染、治疗方式、愈合时间、是否导致化学治疗延迟。根据创面深度,将其分为浅表创面组（30个）和深层创面组（11个）,比较创面合并感染、有无肿瘤侵及、治疗方式、愈合时间及是否导致化学治疗延迟。根据创面有无肿瘤侵及,将其分为肿瘤创面组（11个）和普通创面组（30个）,比较创面合并感染、深度、治疗方式、愈合时间及是否导致化学治疗延迟。根据创面治疗方式,将其分为手术治疗组（23个）和保守治疗组（18个）,比较创面深度、有无肿瘤侵及、合并感染、愈合时间及是否导致化学治疗延迟。结果 32例患儿男19例、女13例,年龄2.0~12.5岁,其中确诊为非霍奇金淋巴瘤者16例、急性髓系白血病者2例、急性淋巴细胞白血病者14例。6个创面为医源性创面,35个创面为非医源性创面。分别有9、9、11、12个创面累及头面颈部、躯干、四肢、臀部和会阴部。10个创面出现在肿瘤化学治疗之前,31个创面出现于肿瘤化学治疗过程中。创面面积为15.00（4.00,48.00）cm²。30个浅层创面、11个深层创面。11个创面有肿瘤侵及,31个创面合并感染。18个创面采取保守治疗,23个创面采取手术治疗。创面愈合时间为70.00（38.50,103.00）d。27个创面导致化学治疗延迟。浅表创面组和深层创面组创面合并感染情况、有无肿瘤侵及、治疗方式、愈合时间及是否导致化学治疗延迟比较,差异均无统计学意义（P>0.05）。肿瘤创面组创面愈合时间明显长于普通创面组（U=78.50,P<0.05）。手术治疗组创面合并感染、导致化学治疗延迟比例明显高于保守治疗组（P<0.05）,创面愈合时间明显短于保守治疗组（ U=112.00,P<0.05）。结论血液系统恶性肿瘤患儿的创面多为非医源性创面、多合并感染、愈合时间较长。创面的存在常导致肿瘤治疗延误,因此对有必要行手术治疗的创面早期识别和处理十分重要,手术治疗可加速创面愈合。
- 儿童 /
- 血液肿瘤 /
- 伤口愈合 /
- 伤口感染 /
- 流行病学 /
- 免疫抑制
Abstract: Objective To explore the epidemiological characteristics and treatment of wounds in pediatric patients with hematologic malignancies. Methods This study was a retrospective case series study. From January 2017 to December 2024, 20 and 12 pediatric patients with hematologic malignancies meeting the inclusion criteria were admitted to Beijing Children's Hospital of Capital Medical University and Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, respectively, yielding a total of 41 wounds. The following data were recorded, including gender, age, and type of hematologic malignancy of pediatric patients, wound etiology, location, time of onset, area, depth, presence of tumor invasion, concurrent infection, treatment modality, healing time, and whether the wound resulted in chemotherapy delay. According to the wound depth, the wounds were divided into superficial wound group (30 wounds) and deep wound group (11 wounds), and wound concurrent infection, presence of tumor invasion, treatment modality, healing time, and whether the wound resulted in chemotherapy delay were compared. According to the presence of tumor invasion, the wounds were divided into tumor-involved wound group (11 wounds) and ordinary wound group (30 wounds), and wound concurrent infection, depth, treatment modality, healing time, and whether the wound resulted in chemotherapy delay were compared. According to the treatment modality, the wounds were divided into surgical treatment group (23 wounds) and conservative treatment group (18 wounds), and wound depth, presence of tumor invasion, concurrent infection, healing time, and whether the wound resulted in chemotherapy delay were compared. Results Among the 32 pediatric patients, 19 were males and 13 were females, aged 2.0 to 12.5 years; 16 were diagnosed with non-Hodgkin lymphoma, 2 with acute myeloid leukemia, and 14 with acute lymphoblastic leukemia. Six wounds were iatrogenic and 35 wounds were non-iatrogenic. Nine, 9, 11, and 12 wounds involved the head, face and neck, trunk, extremities, and buttocks and perineum, respectively. Ten wounds appeared before chemotherapy, and 31 wounds appeared during chemotherapy. The wound area was 15.00 (4.00, 48.00) cm². Thirty wounds were superficial wounds, and 11 wounds were deep wounds. Eleven wounds showed tumor invasion, and 31 wounds had concurrent infection. Eighteen wounds received conservative treatment, and 23 wounds received surgical treatment. The wound healing time was 70.00 (38.50, 103.00) days. Twenty-seven wounds resulted in chemotherapy delay. There were no statistically significant differences between superficial wound group and deep wound group in concurrent wound infection, presence of tumor invasion, treatment modality, healing time, or whether the wound resulted in chemotherapy delay (P>0.05). The healing time of tumor-involved wound group was significantly longer than that in ordinary wound group (U=78.50, P<0.05). The percentages of concurrent infection and chemotherapy delay in surgical treatment group were significantly higher than that in conservative treatment group (P<0.05), with a significantly shorter healing time (U=112.00, P<0.05). Conclusions In pediatric patients with hematologic malignancies, wounds are mostly non-iatrogenic, with frequent concurrent infection and prolonged healing time. Because the presence of wounds frequently delays oncologic treatment, early identification and prompt treatment of wounds for which surgery is indicated are essential, and surgical treatment can accelerate wound healing.
- Child /
- Hematologic neoplasms /
- Wound Healing /
- Wound infection /
- Epidemiology /
- Immunosuppression
朱海：数据采集、论文撰写、病例诊治、统计学分析、论文修改；刘梓钰、郭春来：数据采集、病例诊治；陈琨：病例诊治、研究设计、论文撰写指导、论文审阅、经费支持

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图 1 一例急性淋巴细胞白血病患儿右侧腹股沟创面的治疗效果。1A.右侧腹股沟创面出现第3天,创面深达肌层,较多坏死组织附着；1B.术中修补股动脉和彻底清创后；1C.转移局部皮瓣覆盖创面,缝合创面后；1D.术后37 d拆线后,创面完全愈合

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Table 1. 不同血液系统恶性肿瘤患儿不同部位非医源性和医源性创面分布

血液系统恶性肿瘤类型	创面数（个）		头面颈部（个）		躯干（个）		四肢（个）		臀部和会阴部（个）
血液系统恶性肿瘤类型	非医源性	医源性	非医源性	医源性	非医源性	医源性	非医源性	医源性	非医源性	医源性
非霍奇金淋巴瘤	16	5	6	0	3	4	2	1	5	0
急性淋巴细胞白血病	17	1	2	1	2	0	7	0	6	0
急性髓系白血病	2	0	0	0	0	0	1	0	1	0

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Table 2. 浅表创面组和深层创面组血液系统恶性肿瘤患儿和创面基本资料比较

组别	患者例数	性别（例）		年龄（岁,x¯±s）	创面数（个）	创面部位（个）				创面面积[cm²,M（Q₁,Q₃）]
组别	患者例数	男	女	年龄（岁,x¯±s）	创面数（个）	头面颈部	躯干	四肢	臀部和会阴部	创面面积[cm²,M（Q₁,Q₃）]
浅表创面组	23	14	9	8.3±2.7	30	5	6	9	10	13.40（2.30,36.00）
深层创面组	9	5	4	6.8±2.8	11	4	3	2	2	15.60（4.00,100.00）
统计量值		—		t=1.40		—				U=109.50
P值		>0.999		0.173		0.465				0.265
注：根据创面深度是否达肌层,分为浅表创面组和深层创面组；“—”表示无此项

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Table 3. 浅表创面组和深层创面组血液系统恶性肿瘤患儿创面特征比较

组别	创面数（个）	合并感染（个）		肿瘤侵及（个）		治疗方式（个）		愈合时间[d,M（Q₁,Q₃）]	导致化学治疗延迟（个）
组别	创面数（个）	有	无	有	无	手术治疗	保守治疗	愈合时间[d,M（Q₁,Q₃）]	是	否
浅表创面组	30	22	8	7	23	15	15	63.50（64.00,130.00）	17	13
深层创面组	11	9	2	4	7	8	3	85.00（36.00,94.00）	10	1
统计量值		—		—		—		U=117.50	—
P值		0.700		0.445		0.291		0.162	0.064
注：根据创面深度是否达肌层,分为浅表创面组和深层创面组；“—”表示无此项

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Table 4. 肿瘤创面组及普通创面组血液系统恶性肿瘤患儿和创面基本资料比较

组别	患者例数	性别（例）		年龄（岁,x¯±s）	创面数（个）	部位（个）				创面面积[cm²,M（Q₁,Q₃）]
组别	患者例数	男	女	年龄（岁,x¯±s）	创面数（个）	头面颈部	躯干	四肢	臀部和会阴部	创面面积[cm²,M（Q₁,Q₃）]
普通创面组	25	14	11	8.2±2.7	30	6	6	8	10	13.50（3.58,36.00）
肿瘤创面组	7	5	2	6.9±2.8	11	3	3	3	2	15.00（4.00,100.00）
统计量值		—		t=1.06		—				U=128.00
P值		0.671		0.298		0.788				0.617
注：根据创面有无肿瘤侵及,分为肿瘤创面组和普通创面组；“—”表示无此项

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Table 5. 肿瘤创面组及普通创面组血液系统恶性肿瘤患儿创面特征比较

组别	创面数（个）	合并感染（个）		深度（个）		治疗方式（个）		愈合时间[d,M（Q₁,Q₃）]	导致化学治疗延迟（个）
组别	创面数（个）	有	无	浅表创面	深层创面	手术治疗	保守治疗	愈合时间[d,M（Q₁,Q₃）]	是	否
普通创面组	30	21	9	23	7	17	13	63.50（37.50,86.00）	20	10
肿瘤创面组	11	10	1	7	4	6	5	168.00（64.00,240.00）	7	4
统计量值		—		—		—		U=78.50	—
P值		0.700		0.445		>0.999		0.011	>0.999
注：根据创面有无肿瘤侵及,分为肿瘤创面组和普通创面组；“—”表示无此项

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Table 6. 手术治疗组与保守治疗组血液系统恶性肿瘤患儿和创面基本资料比较

组别	患者例数	性别（例）		年龄（岁,x¯±s）	创面数（个）	部位（个）				创面面积[cm²,M（Q₁,Q₃）]
组别	患者例数	男	女	年龄（岁,x¯±s）	创面数（个）	头面颈部	躯干	四肢	臀部和会阴部	创面面积[cm²,M（Q₁,Q₃）]
手术治疗组	19	10	9	8.1±2.9	23	4	6	6	7	12.00（4.00,36.00）
保守治疗组	13	9	4	7.6±2.8	18	5	3	5	5	18.00（4.25,60.00）
统计量值		—		t=0.45		—				U=192.00
P值		0.471		0.653		0.862				0.693
注：根据创面是否行手术治疗,分为手术治疗组和保守治疗组；“—”表示无此项

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Table 7. 手术治疗组与保守治疗组血液系统恶性肿瘤患儿创面特征比较

组别	创面数（个）	合并感染（个）		深度（个）		肿瘤侵及（个）		愈合时间[d,M（Q₁,Q₃）]	导致化学治疗延迟（个）
组别	创面数（个）	有	无	浅表创面	深层创面	有	无	愈合时间[d,M（Q₁,Q₃）]	是	否
手术治疗组	23	21	2	15	8	6	17	42.00（36.00,97.00）	21	2
保守治疗组	18	10	8	15	3	5	13	86.00（64.25,159.00）	6	12
统计量值		—		—		—		U=112.00	—
P值		0.012		0.291		>0.999		0.013	<0.001
注：根据创面是否行手术治疗,分为手术治疗组和保守治疗组；“—”表示无此项