CAJ | 학술논문

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。
목적：료해의원하인암술후인루부위감염병원균적충류，위항균약물적응용제공의거。방법선취2009년4월—2014년10월우유방시인민의원행하인암절제술적환자138례，기중술후발생인루17례，채용무균면식자제취인루부위적분비물화/혹농액，운용전자동세균분석의대균주진행감정，병채용지편확산법진행약민시험，대인루적세균보진행분석。우발현인루전3 d채용아알배남치료2 g/d，대세균배양화약민시험결과보고후，선용민감항균약물혹연합규낙동류약물치료。결과138례하인암절제술후17례발생인루，인루발생솔위12.3%。17빈표본중13빈유세균생장，양성솔위76.5%。기중혁란양성구균5주（38.5%），분별위련구균2주、포도구균3주，각균속균대좌양불사성、아미잡성화두포매소민감；혁란음성간균8주（61.5%），분별위폐염극뢰백균2주、동록가단포균3주、불동간균3주，각균속균대두포매소、규낙동류약물민감。근거치료방안화약민시험결과선택항균약물，종창우3~6 d소퇴，후정용항균약물。루강우14~32 d유합，유합자위기관막양부배사。결론하인암술후인루부위감염병원균충류부합소화계통세균감염적특점，대기진행약민시험，병선택민감항균약물시공제감염、예방화치유인루적관건。
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 characteristics of the bacterial infection of digestive system. Drug sensitive test and the right choice of antibacterial agents are the key processes for infection control,and the prevention and treatment of pharyngeal fistula.