9 例肛周會陰部壞死性筋膜炎的診斷和治療分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

范雷濤 ¹ , 孫源 ¹ , 楊宏光 ² , 李樹民 ² ,  李春雨 ³

1. ;
2. ;
3. ;

Corresponding?author：

李春雨, Email: lcy133000@163.com

Keywords：

壞死性筋膜炎; 肛周; 會陰部; 皮瓣轉移; 診療

DOI：

10.7507/1007-9424.202003011

Video：

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目的總結肛周和會陰部壞死性筋膜炎的臨床診斷和治療經驗。方法回顧性分析 2014 年 9 月至 2019 年 9 月期間朝陽市中心醫院結直腸肛門外科收治的 9 例肛周壞死性筋膜炎患者的臨床資料。結果 9 例患者中，包括 1 例肛周、會陰部和下腹部壞死性筋膜炎，2 例肛周和會陰部壞死性筋膜炎，6 例肛周壞死性筋膜炎，均采用早期手術清創引流、廣譜抗炎藥物治療、術后加強全身營養支持、換藥清創等綜合治療控制感染。9 例患者的肛周和會陰部壞死性筋膜炎均治愈。3 例陰囊部缺損通過二期轉移皮瓣重建治療，皮瓣無壞死，創面和皮瓣愈合良好。結論早期手術清創引流、使用廣譜抗炎藥物、加強術后全身營養支持、換藥清創等綜合治療壞死性筋膜炎的療效較好。陰囊皮膚缺損二期通過大腿根部皮瓣轉移或直接縫合能縮短患者的創面愈合時間。

Citation： 范雷濤, 孫源, 楊宏光, 李樹民, 李春雨. 9 例肛周會陰部壞死性筋膜炎的診斷和治療分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1301-1304. doi: 10.7507/1007-9424.202003011 Copy

1.	Vick R, Carson CC. Fournier’s disease. Urol Clin North Am, 1999, 26(4): 841-849.
2.	鄭介飛, 屠海霞, 曹玉玨. 綜合治療肛周壞死性筋膜炎十例. 中華燒傷雜志, 2019, 35(4): 311-313.
3.	Schmitz M, Ludolph I, Horch RE. Staged reconstruction of challenging abdominal full thickness wounds caused by necrotizing fasciitis and complicated by occult rectal cancer-a rare combination. Int J Colorectal Dis, 2016, 31(3): 769-770.
4.	Fournier AJ. Gangrene foudroyante delaverge. Med Prat, 1883, 4: 589-597.
5.	Ripley DL. Necrotizing fasciitis. Prim Care Update Ob Gyns, 2000, 7(4): 142-147.
6.	Sorensen MD, Krieger JN, Rivara FP, <italic>et al</italic>. Fournier’s gangrene: population based epidemiology and outcomes. J Urol, 2009, 181(5): 2120-2126.
7.	李春雨. 肛腸病學. 北京: 高等教育出版社, 2013: 136-137.
8.	Voelzke BB, Hagedorn JC. Presentation and diagnosis of fournier gangrene. Urology, 2018, 114: 8-13.
9.	付焱, 張冰, 陳秋菊, 等. 改良負壓封閉引流術治療肛周壞死性筋膜炎的臨床療效觀察. 中華結直腸疾病電子雜志, 2019, 8(1): 54-57.
10.	Chen Y, Wang X, Lin G, <italic>et al</italic>. Successful treatment following early recognition of a case of Fournier’s scrotal gangrene after a perianal abscess debridement: a case report. J Med Case Reports, 2018, 12(1): 193.
11.	Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect, 2010, 75(4): 249-257.
12.	林秋, 竺平, 孫桂東, 等. 肛周壞死性筋膜炎的診治進展. 世界華人消化雜志, 2010, 18(32): 3428-3431.
13.	Misiakos EP, Bagias G, Patapis P, <italic>et al</italic>. Current concepts in the management of necrotizing fasciitis. Front Surg, 2014, 1: 36.
14.	Singh A, Ahmed K, Aydin A, <italic>et al</italic>. Fournier’s gangrene. a clinical review. Arch Ital Urol Androl, 2016, 88(3): 157-164.
15.	Laor E, Palmer LS, Tolia BM, <italic>et al</italic>. Outcome prediction in patients with Fournier’s gangrene. J Urol, 1995, 154(1): 89-92.
16.	何睿, 齊心, 李學松, 等. Fournier壞疽臨床分析12例. 中華臨床醫師雜志: 電子版, 2018, 12(2): 70-74.
17.	Chingkoe CM, Jahed A, Loreto MP, <italic>et al</italic>. Retroperitoneal fasciitis: spectrum of CT findings in the abdomen and pelvis. Radiographics, 2015, 35(4): 1095-1107.
18.	Rogers AD, Shahrokhi S. Surgical management of necrotizing soft tissue infections. (2019-01-05)［2019-04-26］. http://www.uptodate.com/contents/surgical-management-of-necrotizing-soft-tissue-infections.
19.	Sartelli M, Malangoni MA, May AK, <italic>et al</italic>. World Society of Emergency Surgery (WSES) Guidelines for Management of Skin And Soft Tissue Infections. World J Emerg Surg, 2014, 9(1): 57.
20.	中國醫師協會肛腸醫師分會臨床指南工作委員會. 肛周壞死性筋膜炎臨床診治中國專家共識 (2019年版). 中華胃腸外科雜志, 2019, 22(7): 689-693.
21.	潘雪凱, 蘇飛, 蔡小鵬, 等. 壞死性筋膜炎的診治現狀. 中華臨床醫師雜志(電子版), 2016, 10(23): 3608-3611.
22.	Chennamsetty A, Khourdaji I, Burks F, <italic>et al</italic>. Contemporary diagnosis and management of Fournier’s gangrene. Ther Adv Urol, 2015, 7(4): 203-215.
23.	Collin P, Abdullah A, Kherad O, <italic>et al</italic>. Prospective evaluation of clinical and radiologic factors predicting return to activity within6 months after arthroscopic rotator cuff repair. J Shoulder Elbow Surg, 2015, 24(3): 439-445.
24.	Andreasen TJ, Green SD, Childers BJ. Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans. Plast Reconstr Surg, 2001, 107(4): 1025-1035.
25.	Karian LS, Chung SY, Lee ES. Reconstruction of defects after Fournier gangrene: a systematic review. Eplasty, 2015, 15: e18.
26.	李大偉, 趙剛, 唐宇峰, 等. 多學科聯合治療多發傷合并壞死性筋膜炎7例體會. 創傷外科雜志, 2018, 20(9): 647-650.
27.	孫廣峰, 王達利, 魏在榮, 等. 皮片游離移植修復陰囊撕脫傷對精子生成影響的實驗研究及臨床觀察. 中華外科雜志, 2012, 50(1): 45-48.
28.	李笑眉, 羅藝, 康雨龍, 等. 浸浴療法結合紅藍光照射治療肛周大面積壞死性筋膜炎多切口引流術后一例. 中華損傷與修復雜志(電子版), 2019, 14(6): 475-476.

1. Vick R, Carson CC. Fournier’s disease. Urol Clin North Am, 1999, 26(4): 841-849.
2. 鄭介飛, 屠海霞, 曹玉玨. 綜合治療肛周壞死性筋膜炎十例. 中華燒傷雜志, 2019, 35(4): 311-313.
3. Schmitz M, Ludolph I, Horch RE. Staged reconstruction of challenging abdominal full thickness wounds caused by necrotizing fasciitis and complicated by occult rectal cancer-a rare combination. Int J Colorectal Dis, 2016, 31(3): 769-770.
4. Fournier AJ. Gangrene foudroyante delaverge. Med Prat, 1883, 4: 589-597.
5. Ripley DL. Necrotizing fasciitis. Prim Care Update Ob Gyns, 2000, 7(4): 142-147.
6. Sorensen MD, Krieger JN, Rivara FP, <italic>et al</italic>. Fournier’s gangrene: population based epidemiology and outcomes. J Urol, 2009, 181(5): 2120-2126.
7. 李春雨. 肛腸病學. 北京: 高等教育出版社, 2013: 136-137.
8. Voelzke BB, Hagedorn JC. Presentation and diagnosis of fournier gangrene. Urology, 2018, 114: 8-13.
9. 付焱, 張冰, 陳秋菊, 等. 改良負壓封閉引流術治療肛周壞死性筋膜炎的臨床療效觀察. 中華結直腸疾病電子雜志, 2019, 8(1): 54-57.
10. Chen Y, Wang X, Lin G, <italic>et al</italic>. Successful treatment following early recognition of a case of Fournier’s scrotal gangrene after a perianal abscess debridement: a case report. J Med Case Reports, 2018, 12(1): 193.
11. Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect, 2010, 75(4): 249-257.
12. 林秋, 竺平, 孫桂東, 等. 肛周壞死性筋膜炎的診治進展. 世界華人消化雜志, 2010, 18(32): 3428-3431.
13. Misiakos EP, Bagias G, Patapis P, <italic>et al</italic>. Current concepts in the management of necrotizing fasciitis. Front Surg, 2014, 1: 36.
14. Singh A, Ahmed K, Aydin A, <italic>et al</italic>. Fournier’s gangrene. a clinical review. Arch Ital Urol Androl, 2016, 88(3): 157-164.
15. Laor E, Palmer LS, Tolia BM, <italic>et al</italic>. Outcome prediction in patients with Fournier’s gangrene. J Urol, 1995, 154(1): 89-92.
16. 何睿, 齊心, 李學松, 等. Fournier壞疽臨床分析12例. 中華臨床醫師雜志: 電子版, 2018, 12(2): 70-74.
17. Chingkoe CM, Jahed A, Loreto MP, <italic>et al</italic>. Retroperitoneal fasciitis: spectrum of CT findings in the abdomen and pelvis. Radiographics, 2015, 35(4): 1095-1107.
18. Rogers AD, Shahrokhi S. Surgical management of necrotizing soft tissue infections. (2019-01-05)［2019-04-26］. http://www.uptodate.com/contents/surgical-management-of-necrotizing-soft-tissue-infections.
19. Sartelli M, Malangoni MA, May AK, <italic>et al</italic>. World Society of Emergency Surgery (WSES) Guidelines for Management of Skin And Soft Tissue Infections. World J Emerg Surg, 2014, 9(1): 57.
20. 中國醫師協會肛腸醫師分會臨床指南工作委員會. 肛周壞死性筋膜炎臨床診治中國專家共識 (2019年版). 中華胃腸外科雜志, 2019, 22(7): 689-693.
21. 潘雪凱, 蘇飛, 蔡小鵬, 等. 壞死性筋膜炎的診治現狀. 中華臨床醫師雜志(電子版), 2016, 10(23): 3608-3611.
22. Chennamsetty A, Khourdaji I, Burks F, <italic>et al</italic>. Contemporary diagnosis and management of Fournier’s gangrene. Ther Adv Urol, 2015, 7(4): 203-215.
23. Collin P, Abdullah A, Kherad O, <italic>et al</italic>. Prospective evaluation of clinical and radiologic factors predicting return to activity within6 months after arthroscopic rotator cuff repair. J Shoulder Elbow Surg, 2015, 24(3): 439-445.
24. Andreasen TJ, Green SD, Childers BJ. Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans. Plast Reconstr Surg, 2001, 107(4): 1025-1035.
25. Karian LS, Chung SY, Lee ES. Reconstruction of defects after Fournier gangrene: a systematic review. Eplasty, 2015, 15: e18.
26. 李大偉, 趙剛, 唐宇峰, 等. 多學科聯合治療多發傷合并壞死性筋膜炎7例體會. 創傷外科雜志, 2018, 20(9): 647-650.
27. 孫廣峰, 王達利, 魏在榮, 等. 皮片游離移植修復陰囊撕脫傷對精子生成影響的實驗研究及臨床觀察. 中華外科雜志, 2012, 50(1): 45-48.
28. 李笑眉, 羅藝, 康雨龍, 等. 浸浴療法結合紅藍光照射治療肛周大面積壞死性筋膜炎多切口引流術后一例. 中華損傷與修復雜志(電子版), 2019, 14(6): 475-476.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

9 例肛周會陰部壞死性筋膜炎的診斷和治療分析

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