坏死性筋膜炎的临床特征及治疗效果

Clinical characteristics and therapeutic effects of necrotizing fasciitis

目的总结坏死性筋膜炎(necrotizing fasciitis,NF)的临床特征及治疗效果。方法回顾性分析自2015年1月至2021年12月,武汉大学同仁医院暨武汉市第三医院皮肤创面修复中心收治的31例NF患者,入院后采取液体复苏、抗感染、营养支持等综合治疗措施稳定患者全身状况,及时行切开引流,必要时负压封闭引流(vacuum sealing drainage,VSD)辅助治疗,多次手术清创,待创面基底部肉芽组织良好后,予以直接缝合、皮片和/或皮瓣移植修复创面。统计住院时间及手术次数。观察术后伤口愈合情况、皮片及皮瓣成活情况。术后采用电话访谈、门诊复查等方式定期随访,观察患者有无复发情况。结果25例患者伤口愈合良好,移植皮片和/或皮瓣均成活,创面完全封闭。其中22例患者采用直接缝合、皮片和/或皮瓣移植修复创面,3例患者截肢。6例患者因误诊、早期手术不及时、VSD操作不当导致多器官功能衰竭而死亡。25例患者平均住院时间为30.2 d,清创手术1~6次。术后随访1~3个月,患者无复发情况。结论NF具有起病危急,发展迅速,破坏力强,病死率高的特征,需引起足够重视。在明确诊断,充分液体复苏,全身状况相对稳定时,尽早手术干预,积极控制基础疾病及防治并发症,多次手术清创,逐步修复创面,才能达到良好的治疗效果。

Objective To summarize the clinical characteristics and therapeutic effects of necrotizing fasciitis(NF).Methods A retrospective systematic case study was conducted to analyze 31 NF patients admitted to our hospital from January 2015 to December 2021.The general condition of the patients was stabilized by comprehensive treatment such as fluid resuscitation,anti-infection and nutritional support,and open drainage in time.If necessary,vacuum sealing drainage(VSD)was used as an auxiliary treatment,after the granulation tissue at the base of the wound was well,the wound was repaired by direct suture,skin and/or skin flap transplantation.Hospital stay and operation frequency were counted.The wound healing and skin flap survival were observed.The patients were regularly followed up by telephone and outpatient review after surgery to observe whether there was a recurrence.Results Twenty-five patients in this group were cured and discharged,of which 22 patients were repaired with direct sutures,skin and/or skin flap transplantation,and 3 patients had an amputation.Six patients died of multiple organ failure due to misdiagnosis,untimely early operation and improper VSD operation.All sutured wounds healed well,grafts and/or flaps survived,and the wound surface was completely closed.The hospital stay of all patients was4-104 days(average 30.2 d),and debridement was performed 1 to 6 times.The patients were followed up for 1 to 3 months,and no recurrence.Conclusion NF is characterized by critical onset,rapid development,strong destructive force and high fatality rate,which should be paid sufficient attention.When the diagnosis is clear,the fluid resuscitation is sufficient,and the systemic condition is relatively stable,early surgical intervention,active control of underlying diseases and prevention of complications,multiple surgical debridements,and gradual wound repair can achieve a good therapeutic effect.