足菌肿5例临床分析  

Clinical Analysis of Five Cases Mycetoma

作　　者：杨瑞芳 王新卫 王石林 郭再冉 钟文龙 张磊 陈江非 YANG Ruifang;WANG Xinwei;WANG Shilin;GUO Zairan;ZHONG Wenlong;ZHANG Lei;CHEN Jiangfei(Department of Osteomyelitis,Luoyang Orthopaedic Hospital of Henan Province,Luoyang 471000,China;Degree and Graduate Education Luoyang Work Department,Henan University of Traditional Chinese Medicine,Luoyang 471000,China)

机构地区：[1]河南省洛阳正骨医院/河南省骨科医院,骨与关节感染一科,河南洛阳471000 [2]河南中医药大学学位与研究生教育洛阳工作部,河南洛阳471000

出　　处：《中国皮肤性病学杂志》2023年第10期1156-1163,共8页The Chinese Journal of Dermatovenereology

基　　金：国家中医临床研究基地科研专项(2019JDZX107);河南省科技攻关计划项目(182102310487);河南省中医管理局首批青苗人才培养项目(豫中医科教〔2018〕16号)。

摘　　要：目的探讨足菌肿的临床特点及诊断与治疗方法,加深疾病认知,减少临床误诊误治。方法对近6年来本科室收治的5例足菌肿患者的临床特点及治疗进行详细报道,并在中国知网数据库检索2000—2022年发表的“足菌肿”相关中文文献,纳入资料完整的患者13例,分析其临床特点及诊疗方法。结果共纳入18例足菌肿病例,其中男13例,女5例,年龄27~70岁。外伤致皮肤破损(72.22%)是该病常见诱因,足部(77.78%)最常累及,临床多表现为局部肿胀、结节、皮肤破溃,排出含颗粒的脓性或血性分泌物。细菌及真菌培养、组织病理和影像学检查是辅助诊断手段,抗菌药物和手术清创是常用治疗方案。9例(50.00%)患者存在误诊误治病史,多数病程较长,持续2个月~44年不等。结论足菌肿的诊断需综合临床表现、细菌及真菌培养、组织病理及影像学检查,抗菌药物联合手术是常规治疗方案。早期明确诊断,合理规范化治疗是提高足菌肿治愈率和降低致残率的关键。Objective To investigate the clinical characteristics,diagnosis and treatment of mycetoma,deepen the knowledge of the disease and reduce clinical misdiagnosis and mistreatment.Methods The clinical features and treatment of 5 patients with mycetoma admitted to our department in the past 6 years were reported in details.We searched the Chinese database of China National Knowledge Infrastructure(CNKI)for Chinese literature related to Mycetoma published between 2000 and 2022,and analyzed the clinical characteristics,diagnosis,and treatment methods of 13 patients with complete data.Results A total of 18 cases of mycetoma were combined,including 13 males and 5 females aged 27-70 years.Trauma-induced skin breakdown(72.22%)was the common cause of the disease,with the foot(77.78%)being the most commonly involved.Clinical manifestations were mostly localized swelling,nodules,skin breakdown and discharge of pus or blood-containing granules.Bacterial and fungal cultures,histopathology and imaging were diagnostic aids,and antimicrobial drugs and surgical debridement were the usual treatment options.Nine patients(50.00%)had a history of misdiagnosis and mistreatment,and most had a long disease duration,ranging from 2 months to 44 years.Conclusion The diagnosis of mycetoma requires a combination of clinical data,bacterial and fungal cultures,histopathology and imaging.Antimicrobial drugs combined with surgery are the usual treatment options.Early diagnosis and rational treatment are the key to improving cure rates and reducing disability rates.

关 键 词：足菌肿 真菌 放线菌 诊断 治疗 

分 类 号：R756[医药卫生—皮肤病学与性病学] R739.5[医药卫生—临床医学]