Fournier坏疽临床分析12例

Fournier′s gangrene:analysis of 12 cases

目的总结Fournier坏疽(FG)的临床特点、治疗原则及预后。方法回顾性分析2005年1月至2016年12月间就诊于北京大学第一医院整形烧伤外科的FG患者。结果共12例FG患者入组本研究,其中男性11例,女性1例,中位年龄54岁(21~78岁)。10例(83%,10/12)患者有明确病因,其中7例为肛周疾病,1例为阴囊皮肤擦伤,1例为腹膜后脓肿,1例为巴氏腺脓肿。6例(50%,6/12)患者合并糖尿病。除1号患者因呼吸、循环衰竭于入院第8天死亡而未予手术清创外,余11例患者均接受手术清创。中位手术次数7次(3~18次),7例患者接受创面负压吸引治疗(NPWT),中位治疗周期3次(3~7次)。伤口平均愈合时间为(52.7±17.7)d,6例创面植皮修复,5例直接缝合。6例(50%,6/12)患者存在多重细菌感染,6例(50%,6/12)患者为单一细菌感染,肠杆菌科、肠球菌属和溶血葡萄球菌为常见致病菌。中位随访时间32个月,11例患者均存活,且伤口愈合良好。结论坏死性筋膜炎的实验室危险性指标评分是早期诊断与鉴别诊断的重要辅助工具。积极手术清创、经验性广谱抗生素和全身支持治疗是挽救患者生命的关键。创面负压吸引治疗是有效的治疗手段,游离植皮可作为阴茎、阴囊重建的推荐方案。

Objective To summarize the clinical characteristics,therapeutic principle,and outcome of Fournier′s gangrene(FG).Methods A retrospective chart review was performed to analyze all cases of FG patients who presented at Peking University First Hospital from January 2005 to December 2016.Results Twelve patients(11 males and 1 female)were enrolled in this study.The median age was 54 years(range,21-78 years).Etiology was confirmed in ten(83%,10/12)patients,of whom seven suffered from perianal disease,one from abrasion to the skin on the scrotum,one from retroperitoneal abscess,and one from Bartholin′s abscess.Diabetes mellitus was the most common comorbidity associated with FG and was present in six(50%,6/12)patients at the time of admission.One patient died of respiratory and circulatory failure on day 8 without debridement,and the rest patients were treated by repeated surgical debridement.The median number of surgical procedures was seven(range,3-18).Negative pressure wound therapy(NPWT)was applied in seven patients,and the media number of NPWT procedures was three(range 3-7).The mean duration of wound healing was(52.7±17.7)days.There were six patients with defects that healed after split-thickness skin grafting and five with delayed primary closure.Polymicrobial infections were confirmed in six(50%,6/12)patients,while monomicrobial infections were identified in another six(50%,6/12).Enterobacteriaceae,Enterococcus,and Staphylococcus haemolyticus were the most common pathogenic bacteria.During the medial follow-up time of 32 months,11 patients survived with well healed wounds.Conclusions FG is a highly fatal infectious disease.It is important to improve the understanding of FG.Laboratory risk indicator for necrotizing fasciitis(LRINEC)score could be used for early diagnosis and differential diagnosis of FG.Aggressive debridement,empirical broad-spectrum antibiotics,and systemic supportive therapy are the key to saving life.NPWT is an effective adjuvant therapy,and free skin grafting is recommended for the reconstruction of penile and scrotal defects.