Abdominopelvic Actinomycosis--Treatment Outcomes at the Chang Gung Memorial Hospital during the Past 16 Years

郭 益宏, 謝 寶秀, 張簡 俊榮, 陳 進勛, Rei-Ping Tang , Jeng-Yi Wang, 江 支銘, 葉 建裕, 蔡 文司, 洪 欣園

Research output: Contribution to journalJournal Article peer-review


目的 : 放線菌感染為一少見的感染,因為其罕見及多樣的表現使得術前診斷十分困難。本文探討腹部及骨盆腔放線菌感染不同於過去臨床上高劑量,長時期的盤尼西林臨床治療方式及結果。 方法 : 在本文收集了林口長庚醫院大腸直腸外科自1984 年至2001 年腹部及骨盆腔放線菌感染病例共10 例;紀錄所有病例的臨床症狀,子宮內避孕器使用病史,醫學影像,血液生化,外科手術術式,術後抗生素使用時程及術後追蹤狀況。 結果 : 十位病例平均追蹤時間為16 個月,其中八位病患因臨床徵狀疑似大腸直腸或後腹腔惡性腫瘤併周邊器官局部侵犯因而接受廣泛性腫瘤切除手術。一位病患接受切片生檢及手術引流;另一位病患則接受切片生檢及阻塞繞道手術。兩位因有無法手術切除的病灶,分別於接受切片引流及阻塞繞道後接受為期12 及18 個月的抗生素治療。接受廣泛切除的病例於術後並未接受常規性長期的抗生素治療;這些病例在後續追蹤也沒有復發的徵象。 結論 : 在本文,未接受廣泛切除的病例於切片生檢確診後可接受常規性長期的抗生素治療,但因放線菌感染在未接受廣泛切除的病例有復發之機會,應密切接受電腦斷層及理學檢查追蹤。透過手術廣泛的完全移除感染病灶可達到痊癒的治療效果,常規性長期的抗生素治療在這類病患並非絕對需要。
Purpose. Actinomycosis is uncommon and it causes various clinical pictures mimicking cancer, inflammatory disease, or diverticulitis, along with rarity of the disease, the diagnosis of actinomycosis is be difficult. We draw out the optimal treatment modalities for the abdominopelvic actinomycosis in addition to proposed medical management (high- dose penicillin for a long and variable interval, 6 months to 1 year) or combined surgery with antibiotics treatment. Methods. We review the previous cases of actinomycosis in the abdomen and pelvis. They were recruited from 1984 through 2001 at Division of Colon and Rectal Surgery, Department of Surgery in the Chang Gung Memorial Hospital (CGMH). Reviewing the charts, we recorded the clinical manifestations, image findings, white blood cell counts (WBC) and differential counts, surgical procedures, post-operative antibiotics treatment duration, interval of follow-up, and history of IUD use. Results. In our series, the median follow-up period was 16 months (6-153 months). Eight patients (cases 1, 2, 4, 5 and 7-10) underwent radical surgery because the disease was mimicking malignancy morphologically and two patients (case 3 and 6) received prolonged antibiotic treatments after biopsy and bypass. Prolonged antibiotic treatments after radical resection of the lesions were not routine. No relapse even no prolonged antibiotics treatment during follow-up was identified. Conclusion. In our cases, the standard long-term antibiotic treatment could be used in patients having no radical resection. But close follow-up by CT and clinical examination are important in such cases because disease relapse is possible. Surgical intervention alone can cure cases with infection by complete removal of the infection foci, and long-term antibiotic therapy is unnecessary.
Original languageAmerican English
Pages (from-to)49-55
Issue number3
StatePublished - 2009


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