美容手术相关非结核分枝杆菌感染的诊断和治疗方法

Diagnosis and treatment methods of nontuberculous mycobacteria infections related to cosmetic surgery

目的探讨美容手术相关非结核分枝杆菌(NTM)感染的诊断和治疗方法。方法该研究为回顾性观察性研究。2015年1月-2023年12月,南方医科大学深圳医院和北部战区总医院收治符合入选标准的美容手术相关NTM感染患者共24例,均为女性,年龄29~51岁,其中行溶脂针注射术者20例、面部线雕手术者2例、异物注射者1例、除皱手术者1例。NTM导致感染的临床表现:感染部位有散在暗紫红色皮下结节且边界不清,结节表面皮肤变薄伴破溃,破溃口可见粉白色鱼肉样组织及少量淡黄色渗出液。为提高NTM的检出率,可对创面分泌物联合固体组织标本进行细菌培养、多次细菌培养以及延长培养时间等。对感染部位行损伤控制性清创,并根据药物敏感试验结果进行包括使用抗生素在内的综合治疗。统计患者感染NTM的亚型及药物敏感试验结果、创面愈合时间及其间样本的细菌培养次数和手术清创次数。随访时,观察创面愈合情况。结果细菌培养结果显示,感染脓肿分枝杆菌者22例、偶发分枝杆菌者2例。药物敏感试验结果显示,NTM对克拉霉素、阿米卡星、多西环素等抗生素敏感。创面平均愈合时间为83.6 d,其间对标本进行平均2.85次细菌培养,行清创术的平均次数为2.52次。随访6个月~5年,患者创面全部愈合,其中22例患者外观基本正常,遗留轻微瘢痕;2例患者遗留明显瘢痕及凹陷。结论美容手术相关NTM感染的治疗困难,对感染部位进行损伤控制性清创能在保证创面愈合的同时减少对面部等美容部位的损伤及术后畸形。

Objective To investigate diagnosis and treatment methods of nontuberculous mycobacteria(NTM)infections related to cosmetic surgery.Methods This study was a retrospective observational study.From January 2015 to December 2023,24 patients with NTM infections related to cosmetic surgery meeting the inclusion criteria were admitted to Shenzhen Hospital of Southern Medical University and Northern Theater Command General Hospital,all of whom were female and aged 29-51 years.Among them,20 cases underwent lipolysis needle injection surgery,2 cases underwent facial contouring surgery,1 case underwent foreign body injection,and 1 case underwent wrinkle removal surgery.The clinical manifestations of infections caused by NTM included scattered dark purplish subcutaneous nodules at the infection site with unclear boundaries,thinning of the skin on the surface of the nodules and ulceration,and powdery-white fish meat like tissue and a small amount of light yellow exudation being seen at the ulceration.In order to improve the detection rate of NTM,bacterial culture of wound exudation combined with solid tissue samples,multiple bacterial cultures,and extending culture time were performed.All patients were treated with damage control debridement on the infected site and comprehensive treatment including the use of antibiotics based on the results of drug sensitivity tests.The types of NTM infections,drug sensitivity test results,wound healing time,number of bacterial cultures,and surgical debridement times were recorded.The wound healing was observed during follow-up.Results The bacterial culture results showed that there were 22 cases of infections with Mycobacterium abscessus and 2 cases with Mycobacterium fortuitum.The drug sensitivity test results showed that the NTM was sensitive to antibiotics such as clarithromycin,amikacin,and doxycycline.The average healing time of the wound was 83.6 days with an average of 2.85 times bacterial cultures on the specimen,and an average of 2.52 times of debridement surgery.Follow up for 6 months to 5 years,all wounds of the patients were healed.Among them,22 patients had a basically normal appearance with slight scars,while 2 patients had obvious scars and depressions.Conclusions It is difficult to treat NTM infections related to cosmetic surgery.Damage control debridement for the infected site can ensure wound healing and reduce the damage and postoperative deformities in facial and other cosmetic areas.