暴发性阴囊坏疽的局部处理方法探讨

Application of U-shaped stent in Fournier's gangrene

目的 探索暴发性阴囊坏疽的治疗方法。方法 回顾分析 9例暴发性阴囊坏疽治疗方案。 9例患者均行外科清创、冲冼引流、抗感染等治疗 ,其中 4例感染广泛蔓延的患者清创术后 ,采用U形多孔双向引流管引流。 3例外暴露的睾丸暂置于浅表腔隙中 ,二期重建阴囊回纳睾丸。结果 留置U形管引流者 ,重复清创手术的次数明显减少 ,体温及血象恢复正常的时间较普通引流显著缩短 ,术后恢复迅速。结论 暴发性阴囊坏疽的治疗仍以清创及应用抗生素为主 ,术中多毋须切除睾丸。U形多孔双向引流管在清创术后引流效果确切 。

Objective To study the management of Fournier's gangrene.Methods Data of 9 patients were reviewed retrospectively and were discussed according to the treatment,and outcome.U-shaped stents with poly hole and two-end drainage were used in 4 cases in whom the infection was spread along the penis,into the scrotum,up to the abdominal wall and into the perineum.Results We have treated 9 cases in the last 21 years.The patients received surgical treatment including incisions,aggressive debridement,drainage,irrigation,and antibiotic therapy.Left uncovered,the testes were protected in either a thigh or abdominal wall pouch and back in the scrotum resconstructed later with a myocutaneous medial thigh flap.When U-shaped stents was used,redunant debriding was no more necessary.The temperature and hemogram regain quickly,and the average hospitalization days decreased to 14 days.Conclusions Aggressive debridement and broad-spectrum antibiotics remain the hallmarks of treatment.Orchidectomy was erroneously part of the treatment of Fournier's gangrene.The remarkable draining effect of U-shaped stents could promote tissue healing.