联合高压氧综合治疗Fournier坏疽（附14例报告）

Comprehensive management of Fournier＇s gangrene with hyperbaric oxygen therapy：A report of 14 cases

目的探讨Foumier坏疽（Foumier＇s gangrene，FG）的发病因素、诊断、联合高压氧的治疗方法及预后。方法对收治的14例FG患者的临床资料进行回顾性分析，并探讨我们的诊治经验。全部患者均早期采用外科清创引流、足量抗生素抗感染、高压氧等联合治疗措施，清创同时行阴茎切除术＋膀胱造瘘及肠造瘘各1例。II期行阴囊缝合成型术4例，阴囊植皮术8例，阴茎切除术后行尿道外口成型＋阴囊植皮1例。结果痊愈出院13例，仅1例患者因脓毒败血症所致多器官功能衰竭而死亡。结论FG应早期诊断，尽早行广泛清创引流、广谱抗生素及高压氧治疗。待创面无明显炎症反应并长出新鲜肉芽组织后，行II期缝合或植皮术重塑阴囊、会阴部及阴茎皮肤。

Objectives To investigate the etiology, diagnosis, prognosis of hyperbaric oxygen therapy t and prognosis of Fournierg gangrene（FG）. Methods A retrospective study was conducted in our hospital. We ana- lyzed the clinical data of 14 Fournier＇s gangrene cases, and discussed our experience in diagnosis and treatment. All patients were treated with comprehensive treatment measures of early and aggressive debridement and drainage, anti - infection with adequate antibiotic and hyperbaric oxygen therapy. Penile amputation plus suprapubic cystostomy and eolostomy were performed during debridement in 2 cases respectively. During the second session, scrotoplasty was performed for 4 cases, scrotal dermatoplasty for 8, urethral fistulation and scrotal dermatoplasty after penile amputa- tion for 1 case. Results Thirteen patients were recovered and discharged from hospital after our comprehensive treatment, and only one patient died for multiple organ disfunction syndrome （MODS） induced by sepsis. Conclusions Early diagnosis and treatment are very essential for FG patients. Management of FG consists of early and aggressive debridement and drainage, administration of adequate broad - spectrum antibiotics and hyperbaric oxygen therapy. Reconstructing the skin of scrotal, perineum and penis should be proceeded after the wound without signifi- cant inflammation and fresh granulation tissue grows in the second session.