摘要目的 通过清创手术联合药物治疗注射美容致非结核分枝杆菌感染,探讨皮肤软组织非结核分枝杆菌感染的治疗方案.方法 2012年5月至2016年9月,解放军总医院第一附属医院烧伤整形科收治14例注射美容发生皮肤感染在外院长期治疗不愈患者,经手术清创、负压封闭引流,分泌物细菌培养、PCR诊断非结核分枝杆菌,根据药敏结果进行药物治疗.结果 14例患者通过住院规范治疗2～4个月创面愈合出院,出院继续药物治疗12个月,患者均痊愈.随访1～5年,无复发.12例患者面部外观基本正常,遗留轻微瘢痕,2例患者面部手术区皮肤组织凹凸不平,后期组织移植、微等离子束及药物治疗,基本恢复容貌.结论 对注射美容等侵入性操作导致非结核分枝杆菌感染患者,采取合理手术清创联合药物治疗的综合方案治疗非结核分枝杆菌感染能减少继发性损伤.

abstractsObjective To explore the diagnosis and treatment of non-tuberculosis mycobacteria (NTM) infection after cosmetic injection via scientific debridement surgery combined with regular application of anti-NTM drugs.Methods 14 patients who were infected with NTM after cosmetic injection and were not cured over a long period of time in other hospitals from 2012 to 2016.The patients were treated with VSD thorough surgical debridement,the bacterial type of NTM was identified by bacterial culture and PCR identification and anti-NTM drugs were systematically used according to the results of drug sensitivity.Results Fourteen patients who were treated with scientific debridement surgeries combined with regular anti-NTM drug treatment in our hospital for 2-4 months were discharged after their skin lesions were cleared and healed and they were continually treated with antiNTM drugs for 12 months.Fourteen patients were completely cured by using the above treatments without severe side effects,such as liver and kidney dysfunction,nervous system disorders and so on.Only colpitis mycotica occurred in 3 patients.In addition,one patient presented the decrease of leukopenia after using anti-NTM drugs for 2 months and continued to complete the treatment after we adjusted the treatment plan to returning the level of leukopenia to the normal.These 14 patients were followed up for 1-5 years with no recurrence of the lesion.The facial appearance of 12 patients were almost normal with slight scars.The facial surgery area of 2 patients were uneven and nearly recovered to normal facial appearance by tissue transplantation and photoelectric therapy.Conclusions For the NTM patients caused by invasive procedures such as injection,the comprehensive treatment program,which combined scientific debridement surgery and systematically targeted drug treatment,not only can effectively cure NTM infection,but also minimize secondary injury and restore the patients' appearance,which is worthy of clinical application.