肠瘘继发坏死性筋膜炎病例的临床资料分析及死亡危险因素筛查

Analysis of clinical data of necrotizing fasciitis secondary to intestinal fistulas and screening the mortality risk factors

目的分析肠瘘继发坏死性筋膜炎(NF)病例的临床资料,并筛查这些病例的死亡危险因素。方法该研究为回顾性观察性研究。检索2000年1月—2023年10月入住山东第一医科大学附属省立医院(以下简称本单位)且符合入选标准的所有肠瘘继发NF病例的资料,在PubMed、Web of Science、Scopus、中国知网、中华医学期刊网数据库内检索建库至2023年10月符合入选标准的所有肠瘘继发NF病例的资料并进行筛检。按照临床结局,将有效病例纳入存活组(男47例、女24例)和死亡组(男16例、女7例)并计算病死率。对比分析2组病例的临床资料,包括年龄、基础疾病(与NF最相关的病种)、就诊前症状持续时间、白细胞计数、NF原因、腹膜炎体征、NF累及范围、肠道处理措施和创面处理措施,筛选94例肠瘘继发NF患者死亡的危险因素。结果共纳入有效病例为94例,包括文献报告90例、本单位收治病例4例,病死率为24.5%(23/94)。单因素分析结果显示,2组患者年龄、基础疾病、就诊前症状持续时间、白细胞计数、NF原因、腹膜炎体征和NF累及范围比较,差异均无统计学意义(P>0.05);2组患者肠道处理措施和创面处理措施比较,差异均有统计学意义(χ^(2)值分别为17.97、8.33,P<0.05)。多因素logistic回归分析显示,肠道处理措施和创面处理措施均是94例肠瘘继发NF患者死亡的独立危险因素,其中Ⅰ期造瘘+后期重建和负压治疗均具有更高的保护效应(比值比分别为0.05、0.27,95%置信区间为0.01~0.33、0.08~0.88,P<0.05)。结论肠瘘继发NF患者的死亡风险高,在综合治疗的基础上,行积极的肠道和创面处理或许是避免患者死亡的关键,其中Ⅰ期造瘘+后期重建和负压治疗具有更高的保护效应。

Objective To analyze the clinical data and to screen the mortality risk factors of necrotizing fasciitis(NF)secondary to intestinal fistulas(NFsIF).Methods This study was a retrospective observational study.The data of all NFsIF cases who met the inclusion criteria and were admitted into Shandong Provincial Hospital Affiliated to Shandong First Medical University(hereinafter referred to as our unit)from January 2000 to October 2023,and in PubMed,Web of Science,Scopus,China National Knowledge Infrastructure,and Chinese Medical Journal Network databases from its establishment to October 2023 were retrieved and screened.Based on clinical outcomes,the cases were divided into survival group(47 males and 24 females)and death group(16 males and 7 females),and the mortality rate was calculated.Clinical data of patients in the two groups including age,underlying diseases(most related to NF),symptom duration before presentation,white blood cell count,causes of NF,signs of peritonitis,scope of NF involvement,and intestinal management and wound management measures were compared and analyzed to screen the risk factors of death in 94 patients with NFsIF.Results A total of 94 valid cases were collected,including 90 patients reported in the literature and 4 patients admitted to our unit,with the mortality rate of patients being 24.5%(23/94).Univariate analysis showed that there were no statistically significant differences in age,underlying diseases,symptom duration before presentation,white blood cell count,causes of NF,signs of peritonitis,scope of NF involvement between patients in the two groups(P>0.05);there were statistically significant differences in intestinal treatment and wound treatment between the two groups(withχ^(2) values of 17.97 and 8.33,respectively,P<0.05).Multivariate logistic regression analysis showed that both intestinal treatment measures and wound treatments measures were independent risk factors for death in 94 NFsIF patients,among which first-stage colostomy+late-stage reconstruction and negative presssure therapy had higher protective effects(with odds ratios of 0.05 and 0.27,respectively,95%confidence intervals of 0.01-0.33 and 0.08-0.88,respectively,P<0.05).Conclusions The mortality risk of patients with NFsIF is high.Based on comprehensive treatments,active intestinal and wound treatment may be the key to avoid death,with first-stage colostomy+late-stage reconstruction and negative pressure therapy having higher protective effects.