Simon M S, Cody R L
Division of Hematology/Oncology, University of Michigan Cancer Center, Ann Arbor.
Am J Med. 1992 Nov;93(5):543-8. doi: 10.1016/0002-9343(92)90583-w.
We present a series of patients who developed cellulitis following axillary lymph node dissection for carcinoma of the breast. Bacterial cultures were not helpful in making a diagnosis for the majority of the cases. The clinical scenario of upper extremity cellulitis after axillary dissection mimics the presentation of cellulitis in the lower extremity. Until diagnostic methods or treatment advances can eliminate the indications for axillary lymphadenectomy, many women treated for breast cancer will be at long-term risk for the development of cellulitis due to localized immune impairment. Patient and physician awareness of this syndrome is the best available tool to prevent secondary exacerbation of lymphedema. Prompt treatment with appropriate antibiotics appears universally successful. Antistreptococcal antibiotics should not be withheld pending results of blood or tissue cultures, since in only a few cases will a pathogen be isolated. Although there are no studies confirming the concept, it is likely that appropriate treatment for lymphedema may reduce the risk of infection.
我们报告了一系列在因乳腺癌进行腋窝淋巴结清扫术后发生蜂窝织炎的患者。对于大多数病例，细菌培养对诊断并无帮助。腋窝清扫术后上肢蜂窝织炎的临床情况类似于下肢蜂窝织炎的表现。在诊断方法或治疗取得进展能够消除腋窝淋巴结切除术的指征之前，许多接受乳腺癌治疗的女性将因局部免疫功能受损而长期面临发生蜂窝织炎的风险。患者和医生对该综合征的认识是预防淋巴水肿继发性加重的最佳可用手段。使用适当抗生素进行及时治疗似乎普遍有效。不应等待血液或组织培养结果而 withheld 抗链球菌抗生素，因为只有少数病例能分离出病原体。尽管尚无研究证实这一概念，但对淋巴水肿进行适当治疗可能会降低感染风险。 （注：“withheld”这里原英文可能有误，推测可能是“withhold”，暂按此翻译为“ withholding”即“不给予、 withheld 为其过去分词形式” ，实际需结合更准确原文进一步确认 ）
