小儿包皮Fournier坏疽一例诊治并文献复习

Diagnosis and treatment of one pediatric case of foreskin Fournier’s gangrene and review of the literature

目的通过小儿包皮Fournier坏疽的病例及文献复习，加强小儿外科医生对该疾病的再认识，强调快速诊断及治疗的重要性。方法回顾性分析1例小儿包皮Fournier坏疽的临床资料，并检索PubMed、Springer Link、Embase、中国知网（CNKI）、万方数据库中的相关文献资料，结合分析该疾病的发病诱因、临床表现、诊断及治疗、预后情况。结果本例术前快速明确诊断，应用广谱抗生素治疗的同时急诊行手术治疗。完全清创坏死组织，一期行包皮环切手术。术后未再出现坏死病灶，预后良好。检索文献至2015年12月，总共报道8例小儿包皮（或阴茎皮肤）Fournier坏疽病例。发病年龄14 d至14岁（中位年龄14个月），7例有原发基础疾病，其中3例脐炎，3例白血病，1例腹泻，且伴发其他部位的坏疽。1例无原发疾病，伴发阴囊坏疽。平均坏死进展时间为39 h （12～48 h），进行相应部位的清创及对症手术治疗，无死亡病例。结论小儿包皮Fournier坏疽罕见，需要小儿外科医生充分认识、快速诊断、联合治疗，才能减轻患儿痛苦并提高预后。

ObjectiveTo emphasize the importance of identification, early diagnosis and treatment for foreskin Fournier’s gangrene.MethodsThe clinical data were obtained from a child of foreskin Fournier’s gangrene. And the relevant literature information was retrieved from the databases of PubMed, Springer Link, Embase, CNKI and Wanfang until December 2015. Predisposing factors, clinical manifestations, diagnosis, treatment and prognosis were analysed.ResultsRapid accurate diagnosis, early aggressive surgical intervention and usage of broad-spectrum antibiotics were essential. After circumcision surgery was implemented in the premise of complete debridement of necrotic tissue, successful postoperative outcomes were obtained. Eight cases of Fournier’s gangrene in foreskin or penial skin were reported. The median age was 14 months （14 days-14 years）. There were concurrent underlying diseases of omphalitis （n=3）, leukemia （n=3） and diarrhea （n=1）. The average time of necrosis progress were 39 （12-48） hours until operation. Surgical debridement of necrotic tissue was performed with symptomatic supports. No deaths occurred.ConclusionsPediatric prepuce Fournier’s gangrene is rare. However, a surgeon should be fully aware of the importance of its rapid diagnosis and combined therapy to reduce suffering and improve its prognosis.