Adu Ejk, Ampadu E, Acheampong D
Department of Surgery, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Ghana Med J. 2011 Mar;45(1):4-9. doi: 10.4314/gmj.v45i1.68914.
Mycobacterium ulcerans (MU) disease causes extensive destruction of tissues leaving large ulcers on the body. Management which consisted of surgical excision of the lesions is gradually being replaced with chemotherapy.
To study the impact on surgery of prior treatment of MU disease with rifampicin and streptomycin.
Retrospective, from September 2004 to September 2009.
Asunafo, Amansie West, Ahafo Ano and Amansie Central districts of Ghana.
Patients who have completed 8 weeks or a minimum of 4 weeks treatment with rifampicin and streptomycin but have unhealed lesions were selected for surgery.
132 patients had surgery for MU disease; 51 at Tepa (Ahafo Ano); 36 at Agroyesum (Amansie West); 16 from Jacobu (Amansie Central); 29 from Goaso (Asunafo) districts. Their ages ranged from 4 to 98 years, with mean age of 29.90 years, standard deviation of 20.74. Sites involved were: head and neck 1 (0.74%), upper limb 40 (29.63%), lower limb 92 (68.15%), trunk 2 (1.48%) (N=135). The clinical forms were: papule 1 (0.74%), nodule 2 (1.48%), oedematous lesion 4 (2.96%), osteomyelitis 2 (1.48%), ulcers 124 (91.85%), contractures 2 (1.48%). 139 surgical procedures were performed: excision 25 (18.11), skin grafting 36 (26.1%), excision and skin grafting 54 (39.1%), debridem net 10 (7.2%), sequestrectomy 2 (1.4%), regrafting 10 (7.2%), release of contractures 2 (1.4%).
Treatment of MU disease with rifampicin and streptomycin improved the condition and minimised the extent of surgery. Combination of surgery and antibiotics is necessary to prevent the development contractures.
溃疡分枝杆菌病会导致组织广泛破坏，在身体上留下大的溃疡。过去采用手术切除病灶的治疗方法正逐渐被化疗所取代。
研究利福平与链霉素预先治疗溃疡分枝杆菌病对手术的影响。
回顾性研究，时间跨度为2004年9月至2009年9月。
加纳的阿苏纳福、阿曼西西部、阿哈福阿诺和阿曼西中部地区。
选择已完成8周或至少4周利福平和链霉素治疗但病灶未愈合的患者进行手术。
132例患者接受了溃疡分枝杆菌病手术治疗；51例在特帕（阿哈福阿诺）；36例在阿格罗耶苏姆（阿曼西西部）；16例来自雅各布（阿曼西中部）；29例来自戈阿索（阿苏纳福）地区。他们的年龄在4至98岁之间，平均年龄为29.90岁，标准差为20.74。受累部位包括：头颈部1例（0.74%），上肢40例（29.63%），下肢92例（68.15%），躯干2例（1.48%）（n = 135）。临床类型包括：丘疹1例（0.74%），结节2例（1.48%），水肿性病变4例（2.96%），骨髓炎2例（1.48%），溃疡124例（91.85%），挛缩2例（1.48%）。共进行了139例手术：切除25例（18.11%），植皮36例（26.1%），切除加植皮54例（39.1%），清创术10例（7.2%），死骨切除术2例（1.4%），再次植皮10例（7.2%），挛缩松解术2例（1.4%）。
利福平和链霉素治疗溃疡分枝杆菌病改善了病情并减少了手术范围。手术与抗生素联合使用对于预防挛缩的发生是必要的。
