起源于肛门直肠的Fournier坏疽患者的临床结局:重点关注会阴区未受感染的坏疽

Outcomes in patients with Fournier’s gangrene originating from the anorectal region with a particular focus on those without perineal involvement

背景:Fournier坏疽(FG)是一种发生于外生殖器和会阴部的真菌感染。本研究旨在探讨源自肛门直肠、继发于肛瘘和肛周脓肿的FG的临床特征。方法:回顾性收集2013年5月至2017年4月间中山大学附属第六医院和福建中医药大学附属人民医院收治的FG病例,对其临床特征及治疗结局进行分析。结果:60例FG患者纳入研究。最常见的病原微生物是大肠杆菌。影像学和手术探查证实,分别有52例和59例患者病变累及生殖区和直肠周围,但有7例(12%)患者会阴区未被感染。早期彻底清创和应用广谱抗生素治疗效果满意,患者病死率为1.7%。10例患者进行了保护性结肠造口术。无一例患者行睾丸切除术或尿道转流术。结论:原发于肛门直肠区域的FG病情进展迅速,致死率高。肛门直肠的病变可不经会阴组织而直接感染生殖区。要获得满意的治疗效果,必须对坏死组织进行积极的外科清创,但保护性结肠造口则不是必需的。

Background and aim:Fournier’s gangrene(FG)is a fulminant infection in the external genital region and perineum.The present study explored the clinical features of FG originating from the anorectal region,from primary conditions such as anal fistulas and abscesses.Methods:A retrospective analysis was performed in order to identify the factors associated with clinical outcomes in FG patients derived from two hospitals—the Sixth Affiliated Hospital of Sun Yat-sen University and People’s Hospital Affiliated to Fujian University of Traditional Chinese—over the period from May 2013 to April 2017.Results:Sixty FG patients were included in this study.The common causative microorganisms cultured were Escherichia coli species.Genital and perirectal regional involvement was evident in 52 and 59 cases,respectively,although the perineum was unaffected in 7 cases(12%),as confirmed by imaging examination and surgical exploration.Management with early radical debridement and broad-spectrum antibiotic therapy is effective with an acceptably sepsis mortality(1.7%).Ten patients underwent protective colostomy.No patient underwent an orchidectomy and required urinary diversion.Conclusions:FG originating from the anorectal region can be rapidly progressive and life-threatening.Infection can spread superiorly to the genital region without the involvement in perineal tissue.An aggressive surgical debridement of nonviable tissue is essential for satisfactory outcomes and a protective colostomy is not mandatory.