肾移植术后坏死性筋膜炎二例报道

Necrotizing fasciitis after renal transplantation: 2 cases report

目的总结肾移植术后坏死性筋膜炎的临床特征,提高对肾移植术后继发坏死性筋膜炎的认识和诊疗水平。方法 2例肾移植术后继发坏死性筋膜炎病人。发病前2例均经历过有创操作,1例因肾移植术后半年肺部感染于左下肢插管透析辅助治疗,诱发透析管周围软组织感染; 1例因肾移植术后2年发现移植肾上方腹壁下局限性脓肿,行彩超引导下脓肿穿刺后,引起穿刺周围皮下软组织感染。结果 2例病人均在出现发热症状后迅速进入感染性休克状态,1例病人未进行手术治疗,并于24小时内死亡,另外1例经过四次彻底清创手术后治愈。结论肾移植病人免疫力普遍较低,即便是小范围皮肤破损也可以导致坏死性筋膜炎;早期症状不典型容易引起误诊或诊断延迟,临床怀疑坏死性筋膜炎时应当及时手术干预并明确诊断;早期手术、彻底清创引流是决定预后最关键的因素,可有效降低其死亡风险。

Objective To summarize the clinical features of necrotizing fasciitis after renal transplantation,to improve the understanding of the secondary necrotizing fasciitis after renal transplantation as well as the treatment level. Methods We retrospectively analyzed the clinical documents of two patients who had a kidney transplant with secondary necrotizing fasciitis and review literature. Both patients had experienced invasive procedures before the onset of the disease. One was admitted to hospital because of the lung infection,and her developed soft tissue infection of the left leg due to the dialysis tube insertion.Another patient experienced the soft tissue infection of right abdominal wall due to the abscess puncture treatment. Results Septic shock occurred quickly in the two patients. One patient died within 24 hours.Another patient underwent four complete debridement operations before being discharged. Conclusion Kidney transplant patients generally have low immunity,even small areas of skin damage can lead to necrotizing fasciitis;Atypical early symptoms can easily lead to misdiagnosis or delayed diagnosis. When necrotizing fasciitis is suspected clinically,timely surgical intervention and clear diagnosis should be made;Early operation and complete debridement and drainage are the most important prognostic factors and can reduce the risk of death.