中华皮肤科杂志 ›› 2015, Vol. 48 ›› Issue (9): 646-647.

• 研究报道 • 上一篇    下一篇

乳腺癌术后丹毒12例分析

顾吉娜,陈琳   

  1. 宁波市第二医院
  • 收稿日期:2014-11-18 修回日期:2015-03-20 出版日期:2015-09-15 发布日期:2015-09-01
  • 通讯作者: 陈琳 E-mail:chenlin2111@163.com

Erysipelas following breast cancer surgery: 12 case reports

  • Received:2014-11-18 Revised:2015-03-20 Online:2015-09-15 Published:2015-09-01

摘要:

目的 分析12例乳腺癌术后丹毒住院患者的临床特点、细菌学特点及治疗方法。 方法 回顾性分析宁波市三家三级甲等医院确诊的12例乳腺癌术后丹毒患者的临床资料。 结果 8例患者行乳腺癌改良根治术 + 腋窝淋巴结清扫术,3例患者行乳腺癌根治术 + 腋窝淋巴结清扫术,1例患者行乳腺切除术,12例患者均有术后患侧的淋巴水肿。丹毒发生于乳腺癌手术治疗后1 ~ 18年(平均8.0年),4例患者存在复发。8例患者感染部位为手术同侧上肢,1例患者为手术侧胸壁,另1例患者为手术侧下肢,多部位感染者有2例。5例患者行血培养,2例阳性,1例为似马链球菌,另1例为肺炎克雷伯菌。6例患者使用青霉素类抗生素,其中2例初始治疗失败,更换抗生素后,12例患者均好转出院。 结论 乳腺癌术后淋巴水肿的上肢及胸壁容易发生丹毒,病原学上需警惕革兰阴性菌,在抗生素治疗的同时需注重淋巴水肿的治疗。

Abstract:

Gu Jina, Chen Lin. Department of Infectious Disease, Ningbo NO.2 Hospital, Ningbo 315010, China Corresponding author: Chen Lin, Email: chenlin2111@163.com 【Abstract】 Objective To analyze clinical and bacteriological features and therapeutic methods of erysipelas following breast cancer surgery in 12 hospitalized patients. Methods Clinical data on 12 patients with erysipelas following breast cancer surgery were collected from 3 third-grade class-A hospitals in Ningbo. A retrospective study was carried out. Results Of the 12 patients, 8 were treated with modified radical mastectomy and axillary lymph node dissection, 3 with radical mastectomy and axillary lymph node dissection, and 1 with mammectomy only. All of the 12 patients suffered from postoperative lymphedema on the affected side. Erysipelas mostly occurred within 1 - 18 years (mean, 8.0 years) after breast cancer surgery, and on the same side of surgery in all the patients except 2 with multi-site infection. Specifically speaking, erysipelas was located in the upper extremity in 8 patients, in the chest wall in 1 patient, in the lower extremity in 1 patient. Blood culture was performed for 5 patients, of whom, 2 showed positive results, including 1 infected with Streptococcus equisimilis and 1 with Klebsiella pneumonia. Six patients were treated with penicillins, but the primary treatment failed in 2 patients. After replacement of antibiotics, all the 12 patients experienced an improvement of the condition and were discharged from hospital. Conclusions Patients who suffer from lymphedema after breast cancer surgery are prone to erysipelas of the upper limbs and chest wall. Caution should be taken against gram-negative bacterial infections in these pateints. The treatment of lymphedema should be taken into account besides antibiotic therapy.