婴幼儿急性坏死性筋膜炎治疗方式的选择

Alternative treatment options for infantile acute necrotizing fasciitis

目的探讨婴幼儿急性坏死性筋膜炎的早期诊断与治疗方式。方法对2009年1月至2013年6月间收治的15例婴幼儿坏死性筋膜炎分别采用传统小切口引流手术与切开＋负压封闭引流技术（VSD）进行治疗，同时对本疾病的临床特点、早期诊断进行分析。15例患儿年龄6个月至3岁，平均17．5个月。起病时间1～6d，平均2．8d。常见感染部位为下肢，上肢及臀部次之。金黄色葡萄球菌是常见致病菌。手术方式采用传统小切口引流手术6例，负压封闭引流技术（VSD）治疗9例，早期选用广谱抗生素及支持治疗。结果15例患儿均治愈。术后随访6个月患肢功能良好。结论尽管婴幼儿急性坏死性筋膜炎病例较为少见，但后果严重，因此早期诊断极为重要。在准确诊断的同时，及时、恰当的切开引流是本疾病治疗的关键。尽管传统小切口是婴幼儿坏死性筋膜炎治疗的标准术式，对于具有适应证的患儿，切开＋负压封闭引流技术（VSD）也可作为一种有效的治疗方式，并能显著减轻患儿的痛苦。

Objective To explore early diagnosis and treatment of infants with acute necrotizing fasciitis （NF）. Methods A total of 15 infantile cases of NF from January 2009 to June 2013 were re- cruited. Their clinical features and early diagnosis were analyzed. They underwent classic small inci- sion approach （n = 6） or open drainage with vacuum sealing drainage （VSD） （n = 9）. Their mean age was 17. 5 （6-36） months and average onset time 2. 8 （l-6） days. The most common site of initial in- volvement was lower extremities, followed by upper extremities and gluteal region. Staphylococcus aureus was the most common causative microorganism. All of them received appropriate broad-spec- trum aggressive antibiotics and supportive therapy. Results All cases were cured. During a follow-up period of 6 months, excellent functions were achieved for all extremities. Conclusions Although the infections of NF are rare in children, their lethal potentials and early diagnostic signs must be recog- nized. The early diagnosis of acute infantile NF and timely, appropriate incision and drainage are es- sential. In combination with a series of comprehensive treatments, the prognosis is generally good. And VSD may he an important postoperative adjunct for NF.