168例术后伤口龟分枝杆菌感染的治疗与随访观察  

Treatment and a follow-up study on wound infection by Mycobacterium chelonae :report of 168 cases

作　　者：翁坤荣[1] 林战[1] 李国祥[1] 吴若松[1] 吴文华[1] 刘世新[1] 连朝晖[1] 

机构地区：[1]深圳市妇幼保健院,518028

出　　处：《中华结核和呼吸杂志》2004年第5期328-331,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的　总结术后伤口龟分枝杆菌感染的治疗经验。方法　回顾 16 8例非结核分枝杆菌 (NTM)伤口感染患者诊断、治疗及 4年半以来随访情况。根据药敏试验结果 ,抗生素治疗以克拉霉素及丁胺卡那为主 ,疗程 4～ 8个月。其中 10 4例患者在抗生素治疗 1个月后实施根治性病灶切除手术 ,术后继续抗生素治疗 3～ 5个月。结果　抗生素治疗加外科根治性病灶切除 10 4例 ,其中 98例伤口Ⅰ期愈合 ;5 0例用抗生素治疗加伤口换药而治愈 ;8例仅伤口换药 ,未用抗生素治愈 ;5例小儿包皮环切后NTM感染者经抗生素治疗加局部激光治疗而治愈 ;1例疝手术后感染者以丁胺卡那作病灶周围封闭治愈。所有病例经随访 4年半 ,无一例复发。结论　采用敏感抗生素系统治疗加外科根治性病灶切除是NTM伤口感染治疗的重要手段。Objective To summarize the experience of treatment on wound infection by non-tuberculous Mycobacterium (NTM) after operations. Methods A hundred and sixty-eight patients with NTM incision infection were retrospectively reviewed in terms of diagnosis,treatment and follow-up in a period of 4.5 years. On the basis of the results of in vitro drug sensitivity test,the main antibiotics used were clarithromycin and amikacin. The course of therapy was 4-8 months. An extirpative excision was performed in 104 cases following one month treatment by antibiotics and then followed by antibiotic therapy for 3-5 months after excision. Results Primary closure was achieved in 98 of the 104 cases. Fifty patients were cured by the use of antibioctics with dressing change. Eight patients were cured by dressing change without antibiotics. Five children with wound infection by NTM after circumcision were cured by antibiotics with local laser therapy. One patient with infection after hernia operation was cured by amikacin blocking of the area surrounding the lesion.There was no relapse after follow-up for four and half years. Conclusion The study demonstrates that sensitive antibiotics combined with surgery extirpative excision is effective for wound infection by NTM.

关 键 词：术后 伤口 龟分枝杆菌感染 治疗 随访观察 

分 类 号：R619[医药卫生—外科学]