PDF(Pubmed)
Abstract：
Introduction Laparoscopic techniques have become standard for many surgeries, offering benefits such as quicker recovery and less pain. However, port-site infections (PSIs) can occur and pose challenges. PSIs can be early (within seven days) or delayed (after three to four weeks), with delayed PSIs often caused by non-tuberculous mycobacteria (NTMs). NTMs are difficult to treat and do not respond well to antibiotics, leading to prolonged and recurrent infections. Guidelines for PSI management are limited. This summary highlights a case series of 10 patients with PSIs, discussing their treatment experience and presenting a treatment algorithm used at our institute. Methods This is a retrospective study (2015-2020) on chronic port-site infections (PSIs) in laparoscopic surgeries. Data were collected on patient demographics, surgery type, prior treatment, and management at the institute. Results The study analyzed 10 patients with chronic PSIs following laparoscopic surgery between 2015 and 2020. Laparoscopic cholecystectomy was the most frequent index surgery. Three patients had a history of treatment with varying durations of anti-tubercular therapy, one of whom had completed anti-tubercular treatment prior to presentation. Complete surgical excision with histopathological examination and fungal, bacterial and mycobacterial cultures were performed. Seven of the 10 patients were treated with oral ciprofloxacin and clarithromycin combination therapy for three months, two were treated with culture-based antibiotics and one was treated with anti-tubercular therapy. All patients improved on treatment. The mean follow-up period was 52 ± 9.65 months, with no relapses being reported. Conclusion Port-site infections (PSIs) are troublesome complications of laparoscopic surgery that can erode the benefits of the procedure. Delayed PSIs caused by drug-resistant mycobacteria are difficult to treat. Improved sterilization methods and thorough microbiological work-up are crucial. Radical excision and prolonged oral antibiotics are effective treatments. Clinicians should avoid empirical antibiotic therapy to prevent antimicrobial resistance.
摘要：
简介腹腔镜技术已成为许多手术的标准，提供的好处，如更快的恢复和更少的痛苦。然而,港口感染(PSIs)可能会发生并构成挑战。PSI可以提前（七天内）或延迟（三到四周后），通常由非结核分枝杆菌（NTM）引起的延迟PSIs。NTM难以治疗，对抗生素的反应也不好，导致长期和反复感染。PSI管理指南是有限的。本摘要重点介绍了10例PSIs患者的病例系列，讨论他们的治疗经验，并介绍我们研究所使用的治疗算法。方法回顾性研究(2015-2020年)腹腔镜手术慢性港口感染(PSIs)。收集了患者人口统计学数据，手术类型,治疗前,和管理研究所。结果该研究分析了2015年至2020年腹腔镜手术后10例慢性PSIs患者。腹腔镜胆囊切除术是最常见的索引手术。三名患者有不同持续时间的抗结核治疗史，其中一人在就诊前已完成抗结核治疗.完整的手术切除与组织病理学检查和真菌，进行细菌和分枝杆菌培养.10例患者中有7例口服环丙沙星和克拉霉素联合治疗3个月,其中2例接受基于培养物的抗生素治疗,1例接受抗结核治疗.所有患者经治疗好转。平均随访时间为52±9.65个月,没有复发的报道。结论端口部位感染（PSIs）是腹腔镜手术的麻烦并发症，会削弱手术的益处。由耐药分枝杆菌引起的延迟性PSIs难以治疗。改进的灭菌方法和彻底的微生物检查至关重要。根治性切除和长期口服抗生素是有效的治疗方法。临床医生应避免经验性抗生素治疗，以防止抗生素耐药性。
