急性化脓性扁桃体炎并发急性坏死性筋膜炎2例并文献复习

Two cases of acute necrotizing fasciitis caused by acute suppurative tonsillitis and review of the literature

目的:急性坏死性筋膜炎继发于化脓性扁桃体炎在临床病例及既往文献中罕见,其病程进展迅速可导致脓毒性休克和多器官功能衰竭,危及患者生命。方法:本文描述了无任何基础疾病的2例中年男性患者,在发生化脓性扁桃体炎后发生发热、右侧大腿疼痛、肿胀,迅速出现右下肢筋膜坏死和脓毒性休克,伴有急性心衰、肝肾功能等多器官功能损害。从咽部、血液及坏死组织处培养出"化脓性链球菌"。联合给予广谱抗生素、液体复苏、持续床边血液净化等综合治疗。结果:成功救治1例患者,在各器官功能恢复正常进行局部坏死组织清创手术和植皮覆盖。而另1例患者入院后24h内死亡。结论:本文描述2例继发于上呼吸道感染的坏死性筋膜炎病例,一旦确诊发现链球菌血源播散导致坏死性筋膜炎,建议这种转移性病变在常规清创手术前对整体病情进行综合评估。

Objective：Acute necrotising fasciitis secondary to acute suppurative tonsillitis is a rare entity with very a few cases reported in the literature. It is rapidly progressive and can lead to septic shock and multi-organ failure,which will cause life threatening. Method： Two cases of middle-aged male without any history of chronic diseases. The two patient s presented with fever,swelling,and pain over the right leg,and they presented right leg fascia necrosis and septic shock before coming to our emergency room. Complications include myocardial infarction, hepar and renal functional lesion. Streptococcus pyogenes was identified from the pharynx ministry, blood and wound culture samples. Treating with broad-spectrum antibiotic, fluid resuscitation and continuous renal replace- ment therapy. Result： One of them eventually recovered with close to normal and was discharged home after skin grafting of her dehridement,but the other one died within 24 h after admission. Conclusion：Necrotizing fasciitis is a life-threatening soft tissue infectious disease. Once S. pyogenesis identified in pharynx ministry,blood, and wound cultures of a patient with necrotizing fasciitis,it is recommended that the metastatic lesions undergo complete com- prehensive evaluation by the conventional debridement surgery.