摘要
目的：了解医院下咽癌术后咽瘘部位感染病原菌的种类，为抗菌药物的应用提供依据。方法选取2009年4月—2014年10月于潍坊市人民医院行下咽癌切除术的患者138例，其中术后发生咽瘘17例，采用无菌棉拭子提取咽瘘部位的分泌物和/或脓液，运用全自动细菌分析仪对菌株进行鉴定，并采用纸片扩散法进行药敏试验，对咽瘘的细菌谱进行分析。于发现咽瘘前3 d采用亚胺培南治疗2 g/d，待细菌培养和药敏试验结果报告后，选用敏感抗菌药物或联合喹诺酮类药物治疗。结果138例下咽癌切除术后17例发生咽瘘，咽瘘发生率为12.3%。17份标本中13份有细菌生长，阳性率为76.5%。其中革兰阳性球菌5株（38.5%），分别为链球菌2株、葡萄球菌3株，各菌属均对左氧氟沙星、阿米卡星和头孢霉素敏感；革兰阴性杆菌8株（61.5%），分别为肺炎克雷伯菌2株、铜绿假单胞菌3株、不动杆菌3株，各菌属均对头孢霉素、喹诺酮类药物敏感。根据治疗方案和药敏试验结果选择抗菌药物，肿胀于3~6 d消退，后停用抗菌药物。瘘腔于14~32 d愈合，愈合者为气管膜样部坏死。结论下咽癌术后咽瘘部位感染病原菌种类符合消化系统细菌感染的特点，对其进行药敏试验，并选择敏感抗菌药物是控制感染、预防和治愈咽瘘的关键。
Objective To investigate pathogenic bacteria species in pharyngeal fistula induced by hypopharyngeal carcinoma operation in order to provide references for the application of antibacterial agents. Methods We enrolled 138 patients who underwent the ectomy of hypopharyngeal carcinoma in Weifang People′s Hospital from April 2009 to October 2014. Pharyngeal fistula occurred in 17 patients after surgery. We used sterile cotton swab to extract excretion and/or fester from pharyngeal fistula. Automatic bacteria analyzer was used to identify the species of bacterial strains,disk diffusion method was employed to conduct the sensitivity test on antibacterial agents,and bacteria spectrum of pharyngeal fistula was analyzed. In the first 3 days after the detection of pharyngeal fistula,the patients were treated with imipenem by 2 g/d. According to the results of drug sensitivity test following bacterial culture,the therapy of sensitive antibacterial agents alone or combining quinolones was undertaken. Results Among 138 patients, pharyngeal fistula occurred in 17 patients after the ectomy of hypopharyngeal carcinoma,with an incidence of 12. 3%. Of the 17 specimens,growth of bacteria happened in 13 specimens,with a positive rate of 76. 5%. There were 5（38. 5%）strains of gram - positive bacteria,including 2 strains of streptococcus and 3 strains of staphylococci,all sensitive to levofloxacin, amikacin and cephalosporin;there were 8 （ 61. 5%） strains of gram negative bacilli,including 2 stains of klebsiella pneumonia,3 strains of pseudomonas aeruginosa and 3 strains of acinetobacter, all sensitive to cephalosporin and quinolones. After the drug sensitive test and corresponding therapeutic regimen, swell receded between day 3 and day 6,after which the use of antibacterial agents was discontinued. Pharyngeal fistula healed between day 14 and day 32,with the necrosis of the membranous part of trachea. Conclusion Pathogenic bacteria species in pharyngeal fistula induced by hypopharyngeal carcinoma operation has the common c
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第26期3188-3191,共4页
Chinese General Practice
基金
国家重大设备专项课题(2012YQ18011709)--微生物表达谱技术在疾控微生物检测中的效果评价
关键词
咽瘘
下咽肿瘤
感染
药敏试验
Pharyngeal fistula
Hypopharyngeal cancer
Infection
Drug susceptibility test
