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目的描述Buruli溃疡的病理、病原体的形态特征以及治疗特点,以提高对本病的认识。方法复习有关文献,根据临床和病理分析6例下肢及上肢慢性溃疡病人,按照WHO诊断标准作出临床诊断,并皆经病理和PCR检测证实。溃疡采用切除加植皮术治疗。结果5例单发溃疡中左下肢4例,右下肢1例。1例为多发溃疡,病变位于左右下肢及左食指。溃疡直径2.5-6.5cm,平均3.2cm。其特点是皮肤及皮下组织坏死,边缘呈潜行性,底部有黄色坏死物覆盖。溃疡周围皮肤水肿和色素沉着。显微镜下见到细胞外有散在或成团的抗酸杆菌和坏死脂肪细胞-“鬼影细胞”。抗结核药物和抗生素对本组Buruli溃疡无较,5例行手术切除溃疡加植皮术或清创术,除1例复发外,4例治疗效果良好。另1例行清创术换药后溃疡愈合。结论Buruli溃疡可以在我国的亚热带地区发生,因此当遇到久经不愈的慢性皮肤溃疡时,要考虑患有Buruli溃疡的可能性。外科手术仍然是目前治疗Buruli溃疡的主要方法。
Objective To describe the pathology of Buruli ulcer, the morphological characteristics of the pathogen and the characteristics of the treatment in order to improve the understanding of the disease. Methods According to the clinical and pathological analysis of 6 cases of chronic ulcer patients with lower extremity and upper extremity, clinical diagnosis was made according to WHO diagnostic criteria and confirmed by pathology and PCR. Ulcer removal and skin grafting surgery. Results In 5 cases of single ulcer in the left lower limb in 4 cases, right lower limb in 1 case. 1 case of multiple ulcers, lesions in the left and right lower extremity and left index finger. Ulcer diameter 2.5-6.5cm, an average of 3.2cm. It is characterized by skin and subcutaneous tissue necrosis, the edge was stealth, the bottom of the yellow necrosis covered. Skin around the ulcer edema and pigmentation. Under the microscope, there are scattered extracellular or lytic acid-fast bacilli and necrotic fat cells - “ghosting cells”. Anti tuberculosis drugs and antibiotics in this group of Buruli ulcer no more, 5 cases of surgical resection of the ulcer plus skin graft or debridement, except 1 case of recurrence, 4 cases of good treatment. Another case of debridement after ulcer healing. Conclusions Buruli ulcer can occur in the subtropical regions of our country, so consider the possibility of Buruli ulcer when it comes to chronic skin ulcers that have long been unmanaged. Surgery is still the main method of treating Buruli ulcer at present.