阴囊部位Fournier坏疽的外科诊疗分析
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摘要
目的通过分析阴囊部位Fournier坏疽的临床特点、外科诊疗过程及疗效,探讨处理此类疾病的有效方法。方法收集自2015年8月至2017年8月治疗阴囊部位Fournier坏疽的8例患者的临床资料,并对临床诊断、创面清创及后期创面重建过程及治疗结果进行回顾性分析。结果 8例患者阴囊部位细菌培养均呈阳性。UFGSI和LRINEC中位评分为4(2～8)分和2(1～5)分,分数高低与住院天数及病情严重程度相符。其中3例经1次清创、5例经2次清创,之后采用负压辅助系统治疗;待创面新鲜后,采取直接缝合1例,局部皮瓣修复1例,自体中厚皮片植皮6例,均痊愈出院。中位随访16.5(11～23)个月,创面愈合良好,无复发。结论患者的临床表现、细菌培养和UFGSI、LRINEC评分,对于阴囊部位Fournier坏疽的诊断和预后判断具有重要意义。在控制基础疾病的同时,采取早期多次清创,并应用负压辅助系统,以及后期根据创面情况来选择合适的重建方式,均可获得较好的预后效果。
Objective To identify the clinical characteristics, surgical diagnostic process, and therapeutic strategies for scrotal Fournier gangrene. Methods From August 2015 to 2017, the clinical data of 8 patients diagnosed with Fournier gangrene in the scrotum were collected and clinical diagnosis, debridement, wound reconstruction procedure, and therapeutic outcomes were retrospectively analyzed. Results Bacterial culture was positive in all patients. The median score of UFGSI and LRINEC was 4(2 to 8) and 2(1 to 5), respectively. The score was consistent with the duration of hospital stay and the severity of the disease. All patients were given systemic antibiotics and nutritional support. Of the eight cases, 3 underwent debridement once and 5 underwent debridement twice. Vacuum-assisted closure(VAC) was used until the wound became clean. Direct suture was performed in 1 case, local flap repair was performed in 1 case,and autologous intermediate split thickness skin graft was performed in 6 cases. All patients were cured and discharged from the hospital.The median follow-up period was 16.5(from 11 to 23) months. The wounds healed and no recurrence was found. Conclusion Clinical manifestations, bacterial culture, and UFGSI and LRINEC scores are important for the diagnosis and prognosis of scrotal Fournier gangrene. On the basis of controlling basic diseases, early multiple debridement assisted with VAC and suitable wound repair methods such as direct suture, skin grafting and flap repair can both achieve favorable therapeutic effect and prognosis.
Objective To identify the clinical characteristics, surgical diagnostic process, and therapeutic strategies for scrotal Fournier gangrene. Methods From August 2015 to 2017, the clinical data of 8 patients diagnosed with Fournier gangrene in the scrotum were collected and clinical diagnosis, debridement, wound reconstruction procedure, and therapeutic outcomes were retrospectively analyzed. Results Bacterial culture was positive in all patients. The median score of UFGSI and LRINEC was 4(2 to 8) and 2(1 to 5), respectively. The score was consistent with the duration of hospital stay and the severity of the disease. All patients were given systemic antibiotics and nutritional support. Of the eight cases, 3 underwent debridement once and 5 underwent debridement twice. Vacuum-assisted closure(VAC) was used until the wound became clean. Direct suture was performed in 1 case, local flap repair was performed in 1 case,and autologous intermediate split thickness skin graft was performed in 6 cases. All patients were cured and discharged from the hospital.The median follow-up period was 16.5(from 11 to 23) months. The wounds healed and no recurrence was found. Conclusion Clinical manifestations, bacterial culture, and UFGSI and LRINEC scores are important for the diagnosis and prognosis of scrotal Fournier gangrene. On the basis of controlling basic diseases, early multiple debridement assisted with VAC and suitable wound repair methods such as direct suture, skin grafting and flap repair can both achieve favorable therapeutic effect and prognosis.
引文
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[23]KONOFAOS P,HICKERSON W L.A technique for improving cosmesis after primary scrotum reconstruction with skin grafts[J].Ann Plast Surg,2015,75(2):205-207.
[24]孙广峰,王达利,李丽,等.皮瓣重建兔阴囊诱导精原细胞凋亡与热休克蛋白70表达[J].中华男科学杂志,2010,16(7):606-610.
[25]PLIKAITIS C M,MOLNAR J A.Subatmospheric pressure wound therapy and the vacuum-assisted closure device:basic science and current clinical successes[J].Expert Rev Med Devices,2006,3(2):175-184.
[2]YILMAZLAR T,OZTURK E,OZGUC H,et al.Fournier′s gangrene:an analysis of 80 patients and a novel scoring system[J].Tech Coloproctol,2010,14(3):217-223.
[3]WONG C H,KHIN L W,HENG K S,et al.The LRINEC(laboratory risk indicator for necrotizing fasciitis)score:a tool for distinguishing necrotizing fasciitis from other soft tissue infections[J].Crit Care Med,2004,32(7):1535-1541.
[4]CHENNAMSETTY A,KHOURDAJI I,BURKS F,et al.Contemporary diagnosis and management of fournier′s gangrene[J].Ther Adv Urol,2015,7(4):203-215.
[5]PAZ MAYA S,DUALDE BELTRAN D,LEMERCIER P,et al.Necrotizing fasciitis:an urgent diagnosis[J].Skeletal Radiol,2014,43(5):577-589.
[6]DOLUOGLUOG,KARAGOZ MA,KILINC MF,et al.Overview of different scoring systems in Fournier′s gangrene and assessment of prognostic factors[J].Turk J Urol,2016,42(3):190-196.
[7]GOH T,GOH L G,ANG C H,et al.Early diagnosis of necrotizing fasciitis[J].Br J Surg,2014,101(1):e119-125.
[8]OSBUN N,HAMPSON L A,HOLT S K,et al.Low-volume vs high-volume centers and management of fournier′s gangrene in washington state[J].J Am Coll Surg,2017,224(3):270-275.
[9]FERRETTI M,SAJI A A,PHILLIPS J.Fournier′s gangrene:a review and outcome comparison from 2009 to 2016[J].Adv Wound Care(New Rochelle),2017,6(9):289-295.
[10]TANG L M,SU Y J,LAI Y C.The evaluation of microbiology and prognosis of fournier′s gangrene in past five years[J].Springerplus,2015,4:14.
[11]YE J,XIE T,WU M,et al.Negative pressure wound therapy applied before and after split-thickness skin graft helps healing of fournier gangrene:a case report(CARE-Compliant)[J].Medicine(Baltimore),2015,94(5):e426.
[12]LIN W T,CHAO C M,LIN H L,et al.Emergence of antibiotic-resistant bacteria in patients with fournier gangrene[J].Surg Infect(Larchmt),2015,16(2):165-168.
[13]AGARWAL L,YASIN A.Necrotising fasciitis:a fatal case of sepsis and a diagnostic challenge-case report and review of literature[J].Int J Emerg Med,2018,11(1):23.
[14]VOELZKE B B,HAGEDORN J C.Presentation and diagnosis of fournier gangrene[J].Urology,2018,114:8-13.
[15]KAUFMANN J A,RAMPONI D.Recognition of risk factors and prognostic indicators in fournier′s gangrene[J].Crit Care Nurs Q,2015,38(2):143-153.
[16]SEN H,BAYRAK O,ERTURHAN S,et al.Is hemoglobin A1c level effective in predicting the prognosis of fournier gangrene?[J].Urol Ann,2016,8(3):343-347.
[17]GARCIA MARIN A,TUREGANO FUENTES F,CUADRADOAYUSO M,et al.Predictive factors for mortality in fournier′gangrene:a series of 59 cases[J].Cir Esp,2015,93(1):12-17.
[18]BOZKURT O,SEN V,DEMIR O,et al.Evaluation of the utility of different scoring systems(FGSI,LRINEC and NLR)in the management of fournier′s gangrene[J].Int Urol Nephrol,2015,47(2):243-248.
[19]GHODOUSSIPOUR S B,GOULD D,LIFTON J,et al.Surviving fournier′s gangrene:multivariable analysis and a novel scoring system to predict length of stay[J].J Plast Reconstr Aesthet Surg,2018,71(5):712-718.
[20]HONG K S,YI H J,LEE R A,et al.Prognostic factors and treatment outcomes for patients with fournier′s gangrene:a retrospective study[J].Int Wound J,2017,14(6):1352-1358.
[21]MISIAKOS E P,BAGIAS G,PAPADOPOULOS I,et al.Early diagnosis and surgical treatment for necrotizing fasciitis:a multicenter study[J].Front Surg,2017,4:5.
[22]AKILOV O,POMPEO A,SEHRT D,et al.Early scrotal approximation after hemiscrotectomy in patients with fournier′s gangrene prevents scrotal reconstruction with skin graft[J].Can Urol Assoc J,2013,7(7-8):E481-485.
[23]KONOFAOS P,HICKERSON W L.A technique for improving cosmesis after primary scrotum reconstruction with skin grafts[J].Ann Plast Surg,2015,75(2):205-207.
[24]孙广峰,王达利,李丽,等.皮瓣重建兔阴囊诱导精原细胞凋亡与热休克蛋白70表达[J].中华男科学杂志,2010,16(7):606-610.
[25]PLIKAITIS C M,MOLNAR J A.Subatmospheric pressure wound therapy and the vacuum-assisted closure device:basic science and current clinical successes[J].Expert Rev Med Devices,2006,3(2):175-184.