醫源性腮腺膿瘍－病例報告

Iatrogenic Parotid Abscess – Case Report

林志峰(Chih-Feng Lin) ； 葉啟偉(Chi-Wei Yeh)

《中華民國耳鼻喉科醫學會雜誌》 32卷6期 (1997/12) Pp. 747-751

https://doi.org/10.6286/1997.32.6.747

摘要

腮腺震瘍在臨床上並不多見，而且多為急性化膿性腮腺炎惡化所造成，一般致病轉機為細菌經由Stensen氏管開口逆行性感染所造成。本院耳鼻喉科於1995年10月經歷1名病患因右側腮腺腫大接受針灸、膏藥治療數日後併斷巨大腮腺膿瘍合併菌血症之病例，膿瘍膿汁及血液培養結果均為格蘭氏陰性之厭氧菌Citrobacter diversus。在予以廣效性抗生素下，病人先後接受膿瘍切開引流術及淺葉腮腺切除術後，直接縫合傷口，追蹤至今，狀況良好。因此病例之致病機轉特殊，醫學文獻中尚未有類似之報告，故提出討論，以供參考。

關鍵字

針灸 ； 腮腺震瘍 ； 菌血症

並列摘要

Parotid abscess, uncommon in clinical practice, usually results from advanced developement from acults from advanced developement from acute suppurative parotitis. The common pathogenesis is retrograde bacteria infection via Stensen's duct by S. aureus and streptococcus species.
A 72-year-old male patient developed a huge parotid abscess with bacteremia within 4 days after he received acupuncture and plaster therapy for his right parotid mass. Citrobacter diversus was revealed from both pus and blood culture. Citrobacter diversus is a species of anaerobic gram-negative bacteria that is rarely seen in parotid abscess but usually found in device or procedure related nosocomial infection in the literature. The patient was given wide-spectrum antibiotics to cover possible pathogenic bacteria. Then he underwent two operations: an urgent incision and drainage, and subsequent superficial parotidectomy. This patient was discharged one month after admission and no recurrence or complication was noted in our OPD follow-up.
In our studies, this is the first report of acupuncture-induced parotid abscess with bacteremia caused by Citrobacter diversus in the literature.

並列關鍵字

acupuncture ； parotid abscess ； bacteremia