面部溶脂针注射致非结核分支杆菌感染的救治策略

摘要

目的:回顾性分析经小切口适度清创配合规律抗结核治疗面部注射溶脂针后非结核分枝杆菌感染并发症的方法,探讨面部非结核分支杆菌感染合理、有效的救治策略.方法:2009年4月至2015年7月我科共收治9例面部注射溶脂术后合并非结核分枝杆菌感染患者,采用在感染灶设计3~5mm小切口,进行多次的适度清创、持续负压吸引、间断冲洗,静脉给予硫酸阿米卡星注射液、乳酸环丙沙星氯化钠注射液,口服异烟肼片、利福喷丁胶囊抗结核治疗,口服联苯双酯滴丸保护肝脏功能,辅助理疗等综合治疗;出院后口服异烟肼片、利福喷丁胶囊、吡嗪酰胺胶囊、克拉霉素胶囊抗结核治疗6~12个月.结果:经30~90d院内上述综合方法治疗,感染病灶基本愈合;院外继续口服药物抗结核治疗,8例13部位在保持正常面部容貌的前提下,非结核分支杆菌得到治愈,1例患者因院外用药不规律,出院后2个月病灶复发,继续住院再次上述治疗后治愈;随访1~4年均无复发,经门诊激光治疗,面部外观得到进一步改善.结论:对面部注射溶脂术后合并非结核分枝杆菌感染的患者,采取上述综合治疗策略,不仅能有效控制非结核分支杆菌感染,而且能减少面部损伤,减少治疗美容注射术后并发症的二次损伤,可恢复至正常外观,值得临床推广.%Objective To analyze the moderate debridement through mini-incision coordinated with regular anti-tuberculosis therapy after injection lipolysis combined with non-tuberculous mycobacteria infection retrospectively,and to explore the reasonable and effective treatment strategies for facial infection with non-tuberculous mycobacteria. Methods From April 2009 to July 2015,9 patients admitted in our department who suffered from non-tuberculous mycobacteria infection after injection lipolysis. Through 3-5mm tiny incision located in infection, several moderate debridement,continuous negative pressure suction and intermittent flushing. Intravenous injection medicines: Amikacin Sulfate Injectio,Ciprofloxacin Lactate And Sodium Chloride, oral anti-tuberculosis medicines: Isoniazid Tablets, Rifapentin Capsules,and Bifendate Pills to protective liver,combined with physiotherapy. After leaving hospital, continue oral anti-tuberculosis medicines: Isoniazid Tablets,Rifapentin Capsules,Pyrazinamide Capsules,Clarithromycin Capsules for 6-12 months. Results Through 30-60d above-mentioned comprehensive measures in hospital, the infection lesions got healed primarily. After leaving hospital, eight patients with 13 infection lesions all got healed and regained normal appearance. After 1-4 years following-up,all of them no recurrence. Through the laser treatment, ther appearances had further improvement. One of patients did not take oral anti-tuberculosis medicine regularly, leaving hospital 2 months later, the infection lesions recurred. So she had to be hospitalized again and recalculated anti-tuberculosis courses of treatment. Conclusion For injection lipolysis combined with non-tuberculous mycobacteria infected patients, taking above-mentioned comprehensive measures not only can control the non-tuberculous mycobacteria infection, but also can reduce facial injury, and can reduce second damage after curing injection complications, and help return back to normal appearance.This kind therapy is worth to be popularized in clinic.