Kawamura Ichiro, Hirashima Yasuyuki, Tsukahara Mika, Mori Keita, Kurai Hanako
1Division of Infectious Diseases, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan.
2Division of Gynecology, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan.
Surg Infect (Larchmt). 2015 Jun;16(3):244-6. doi: 10.1089/sur.2014.021. Epub 2015 Feb 4.
Pelvic lymphocyst infection is a rare complication after lymphadenectomy for malignant gynecologic tumors. Although medical therapy is a useful addition to surgical drainage, the appropriate antibiotic regimen is unknown because few studies have examined the causative organisms. The purpose of this case series was to identify the micro-organisms infecting pelvic lymphocysts.
This was a single-center, retrospective, case-series review conducted at a tertiary-care cancer center between October 2002 and March 2013. The participants included all patients who experienced their first pelvic lymphocyst infection after undergoing pelvic lymphadenectomy for cervical, endometrial, or ovarian cancer and exhibited positive lymphocyst fluid culture. Computed tomography- or sonography-guided percutaneous aspiration procedures were performed to obtain lymphocyst fluid for culture.
During the study period, 878 patients underwent lymphadenectomy for gynecologic malignant tumors, and 13 developed a pelvic lymphocyst infection documented microbiologically. Cultures identified Staphylococcus aureus (three patients), S. epidermidis (one patient), Streptococcus agalactiae (three patients), Enterococcus (two patients), Escherichia coli (one patient), and anaerobic bacteria (three patients). They were all monomicrobial infections.
Our study and other smaller ones suggest that lymphocyst infections following pelvic lymphadenectomy for malignant gynecologic tumors usually are monomicrobial and caused by gram-positive cocci, including Staphylococcus, Streptococcus, and Enterococcus, and anaerobes such as Bacteroides fragilis. These bacteria should be considered when selecting empiric antibiotic therapy.
盆腔淋巴囊肿感染是妇科恶性肿瘤淋巴结清扫术后一种罕见的并发症。尽管药物治疗是手术引流的有益辅助手段，但由于很少有研究检测致病微生物，所以合适的抗生素治疗方案尚不清楚。本病例系列研究的目的是确定感染盆腔淋巴囊肿的微生物。
这是一项在三级癌症中心于2002年10月至2013年3月期间进行的单中心、回顾性病例系列研究。参与者包括所有在接受宫颈癌、子宫内膜癌或卵巢癌盆腔淋巴结清扫术后首次发生盆腔淋巴囊肿感染且淋巴囊肿液培养呈阳性的患者。采用计算机断层扫描或超声引导下经皮穿刺抽吸术获取淋巴囊肿液进行培养。
在研究期间，878例患者接受了妇科恶性肿瘤淋巴结清扫术，其中13例发生了经微生物学证实的盆腔淋巴囊肿感染。培养结果鉴定出金黄色葡萄球菌（3例患者）、表皮葡萄球菌（1例患者）、无乳链球菌（3例患者）、肠球菌（2例患者）、大肠埃希菌（1例患者）和厌氧菌（3例患者）。所有均为单一微生物感染。
我们的研究及其他规模较小的研究表明，妇科恶性肿瘤盆腔淋巴结清扫术后的淋巴囊肿感染通常为单一微生物感染，由革兰氏阳性球菌引起，包括葡萄球菌、链球菌和肠球菌，以及诸如脆弱拟杆菌等厌氧菌。在选择经验性抗生素治疗时应考虑这些细菌。
