阴囊坏疽的治疗体会(附14例报告)

Experience in the treatment of scrotal gangrene(report of 14 cases)

目的总结阴囊坏疽的治疗方法。方法2003年8月至2005年6月诊治阴囊坏疽14例,患者年龄27～74岁,平均48岁。阴囊坏疽并发肛周、阴茎坏疽者2例,并发肛周、阴茎、腹股沟区坏疽者10例,并发肛周、阴茎、腹股沟区、腹部皮下坏疽者2例。其中并发阴茎坏死3例,并发睾丸炎5例。14例细菌培养均为阳性。14例均采用I期清创、阴囊成形、置管引流术,同时给予抗炎对症治疗。3例阴茎坏死者行阴茎全切、尿道造瘘术,2例腹部坏疽者行腹部皮下切开清创引流,5例睾丸炎者行单侧睾丸切除。结果12例阴囊成形术I期愈合,2例尿道造瘘术患者痊愈出院。10例阴茎皮肤坏疽者1个月后阴茎植皮,痊愈出院。死亡2例。结论早期及时清创和抗炎对症治疗是治疗本病的关键,Ⅰ期清创、阴囊成形及置管引流是治疗阴囊坏疽的有效方法。

Objective To summarize the management of scrotal gangrene. Methods Totally,14 male patients （mean age ,48 years ;age range ,27 -74 years） with scrotal gangrene were treated from August 2003 to June 2005. Among these patients,scrotal gangrene was complicated by perianal and penile gangrene in 2 cases;by perianal, penile and inguinal gangrene in 10 cases ;by perianal, penile,inguinal gangrene and abdominal subcutaneous gangrene in 2 cases. Three cases had concomitantly necrosis of the penis ;and 5 ca- ses ,orchitis. Bacterial cultures were performed in all 14 cases with the positive results. All patients underwent surgical treatment,including Phase Ⅰ incisions, aggressive debridement, drainage, irrigation, and scrotoplasty. After operation they received antibiotic therapy and supporting treatment. Three cases of penile necrosis underwent complete penis amputation and transplanting the urethra before the anus. Five cases of orchitis underwent unilateral orchiectomy. Two cases of abdominal gangrene underwent surgical subcutaneous treatment, including incision, aggressive debridement, drainage, and irrigation. Results Twelve cases undergoing scrotoplasty achieved Phase Ⅰ healing. Two cases undergoing urethral fistulation recovered well. Ten cases of penile skin gangrene received penile dermatoplasty 1 month later,and then recovered. Two cases who had already had AⅠDS died 2 or 3 d after operation. Conclusions The management of scrotal gangrene primarily consists of early and aggressive debridement, antibiotic therapy and supporting treatment. The Phase Ⅰ debridement and scrotoplasty as well as drainage are effective for the treatment of scrotal gangrene.