摘要
目的总结肛周坏死性筋膜炎（FG）的临床特征，探讨该病的治疗方法。方法回顾性分析2010年1月至2012年2月南京中医药大学第三附属医院收治的12例FG患者的临床资料。11例因肛周脓肿就诊，1例因肛周异物就诊，大部分患者表现为肛周疼痛、高热（〉38．5℃）和心动过速。患者发病至入院时间为3—20d，平均8d。其中7例患者合并糖尿病，仅2例患者术前服用降糖药，但血糖控制不好；6例患者合并高血压；1例患者2个月前有乙状结肠癌手术史。入院后进行相关体格检查和实验室检查。所有患者完善检查后，急诊行局部清创引流术，选取切除组织送病理检查，术后先经验性用药，再进行分泌物培养，以药物敏感试验结果指导抗感染治疗，术后定期双氧水冲洗切口，并观察疾病进展情况，一旦进展，立即再次行清创术。采用门诊和电话随访至2012年6月，了解患者恢复情况。结果临床特征：肛周组织坏死、发黑，坏死组织侵犯阴囊或大阴唇并延及下腹部8例，最高达脐下，两侧达腋中线；可闻及捻发音；可嗅及特殊臭味。外院转入的5例患者可见下腹部切口，大腿部蔓延2例，最远达膝关节。实验室检查：WBC（3．8—27．6）×10-9／L，6例wBC〉10×10-9／L，3例wBC〉20×10-9／L；中性粒细胞占0．61—0．93。12例患者中，4例单次清创，5例2次清创，3例〉2次清创。2例患者术后发生脓毒血症、感染性休克，分别送人ICU治疗3d和4d后病情好转，转入普通病房。11例患者中脓液培养结果为大肠埃希菌6例（1例为产超广谱B内酰胺酶型）、肺炎克雷伯菌4例、铜绿假单胞菌1例。术后经病理检查确诊为FG。住院时间为1—49d，平均住院时间为25d；术后随访4—29个月，1例患者术后第2天自动出院，预后不详；其他患者均无死亡。结论FG的临床特征为肛周皮下组织坏疽引起的剧烈疼痛和感染迅速蔓延，糖尿病可能是其危险因素。早期诊断、积极外科清创和抗感染等综合治疗的效果确切。
Objective To investigate the clinical fea- tures and therapy of fournier＇s gangrene. Methods The clinical data of 12 patients with fournier＇s gangrene who were treated at the Third Affiliated Hospital of Nanjing University of Chinese Medicine from January 2010 to February 2012 were retrospectively analyzed. Eleven patients had perianal abscess and 1 patient had perianal foreign body, most of the patients were presented with perianal pain, fever （ 〉 38.5 ℃ ） and tachycardia. The mean in- terval between the onset of symptoms and admission to the hospi- tal was 8 days （range, 3-20 dyas）. Seven patients were compli- cated with diabetes. Only 2 patients were administered hypogly- cemic agents, but the effects were poor. Six patients were com- plicated with hypertension. One patient had the history of resec- tion of sigmoid colon cancer 2 months before operation. Debride- ment and drainage were applied to all the patients after examina- tion. Antimicrobial therapy applied to all the patients according to the results of drug sensitivity test. The incisions were washed by hydrogen peroxide solution postoperatively. Redebridement was applied if the disease was progressed. All patients were fol- lowed up via out-patient examination and phone call till June 2012. Results Results of clinical features： Perianal tissues necrotized, with the color of black. The scrotum or labia majora of 8 patients were invaded by the necrotic tissues. Results of labora- tory test： the white blood cell count was （3.8-27.6） × 109/L, the white blood cell count of 6 patients was above 10 × 109/L, 3 was above 20× 109/L. The ratio of neutrophil granulocytes was 0.61-0.93. Four patients received single debridement, 5 re- ceived redebridement, and 3 patients received debridement for more than 2 times. Two patients had sapremia and infectious shock, and they received treatment for 3 days and 4 days at the intensive care unit. Results of bacterial culture： 6 patients were infected by the escherichia coli, 4 by klebsiella pnenmoniae, and 1 by pseudomonas aeruginosa. The mean duration of hospital stay was （25 - 14）days （range, 1-49 days）. All patients were followed up for 4-29 months, 1 patient was discharged at postop- erative day 2, and the prognosis of the 11 patients was good, no mortality was observed. Conclusions The clinical features of fournier＇s gangrene include severe pain and rapid spread of infec- tions caused by necrosis of perianal subcutaneous tissues. Diabe- tes might be the risk factor of fouruier＇s gangrene. Early diagno- sis and prompt and aggressive surgical debridement are critical for improving survival.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2014年第3期218-219,共2页
Chinese Journal of Digestive Surgery
关键词
肛周感染
坏死性筋膜炎
发病因素
清创
治疗
Perianal infection
Necrotizing fasciitis
Etidogy
Debridement
Treatment
