9 例肛周会阴部坏死性筋膜炎的诊断和治疗分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

范雷涛 ¹ , 孙源 ¹ , 杨宏光 ² , 李树民 ² ,  李春雨 ³

1. ;
2. ;
3. ;

Corresponding author：

李春雨, Email: lcy133000@163.com

Keywords：

坏死性筋膜炎; 肛周; 会阴部; 皮瓣转移; 诊疗

DOI：

10.7507/1007-9424.202003011

Video：

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目的总结肛周和会阴部坏死性筋膜炎的临床诊断和治疗经验。方法回顾性分析 2014 年 9 月至 2019 年 9 月期间朝阳市中心医院结直肠肛门外科收治的 9 例肛周坏死性筋膜炎患者的临床资料。结果 9 例患者中，包括 1 例肛周、会阴部和下腹部坏死性筋膜炎，2 例肛周和会阴部坏死性筋膜炎，6 例肛周坏死性筋膜炎，均采用早期手术清创引流、广谱抗炎药物治疗、术后加强全身营养支持、换药清创等综合治疗控制感染。9 例患者的肛周和会阴部坏死性筋膜炎均治愈。3 例阴囊部缺损通过二期转移皮瓣重建治疗，皮瓣无坏死，创面和皮瓣愈合良好。结论早期手术清创引流、使用广谱抗炎药物、加强术后全身营养支持、换药清创等综合治疗坏死性筋膜炎的疗效较好。阴囊皮肤缺损二期通过大腿根部皮瓣转移或直接缝合能缩短患者的创面愈合时间。

Citation： 范雷涛, 孙源, 杨宏光, 李树民, 李春雨. 9 例肛周会阴部坏死性筋膜炎的诊断和治疗分析. 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.	郑介飞, 屠海霞, 曹玉珏. 综合治疗肛周坏死性筋膜炎十例. 中华烧伤杂志, 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.
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7.	李春雨. 肛肠病学. 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, 张冰, 陈秋菊, 等. 改良负压封闭引流术治疗肛周坏死性筋膜炎的临床疗效观察. 中华结直肠疾病电子杂志, 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, 孙桂东, 等. 肛周坏死性筋膜炎的诊治进展. 世界华人消化杂志, 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, 齐心, 李学松, 等. Fournier坏疽临床分析12例. 中华临床医师杂志: 电子版, 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.	中国医师协会肛肠医师分会临床指南工作委员会. 肛周坏死性筋膜炎临床诊治中国专家共识 (2019年版). 中华胃肠外科杂志, 2019, 22(7): 689-693.
21.	潘雪凯, 苏飞, 蔡小鹏, 等. 坏死性筋膜炎的诊治现状. 中华临床医师杂志(电子版), 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.	李大伟, 赵刚, 唐宇峰, 等. 多学科联合治疗多发伤合并坏死性筋膜炎7例体会. 创伤外科杂志, 2018, 20(9): 647-650.
27.	孙广峰, 王达利, 魏在荣, 等. 皮片游离移植修复阴囊撕脱伤对精子生成影响的实验研究及临床观察. 中华外科杂志, 2012, 50(1): 45-48.
28.	李笑眉, 罗艺, 康雨龙, 等. 浸浴疗法结合红蓝光照射治疗肛周大面积坏死性筋膜炎多切口引流术后一例. 中华损伤与修复杂志(电子版), 2019, 14(6): 475-476.

1. Vick R, Carson CC. Fournier’s disease. Urol Clin North Am, 1999, 26(4): 841-849.
2. 郑介飞, 屠海霞, 曹玉珏. 综合治疗肛周坏死性筋膜炎十例. 中华烧伤杂志, 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. 肛肠病学. 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, 张冰, 陈秋菊, 等. 改良负压封闭引流术治疗肛周坏死性筋膜炎的临床疗效观察. 中华结直肠疾病电子杂志, 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, 孙桂东, 等. 肛周坏死性筋膜炎的诊治进展. 世界华人消化杂志, 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, 齐心, 李学松, 等. Fournier坏疽临床分析12例. 中华临床医师杂志: 电子版, 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. 中国医师协会肛肠医师分会临床指南工作委员会. 肛周坏死性筋膜炎临床诊治中国专家共识 (2019年版). 中华胃肠外科杂志, 2019, 22(7): 689-693.
21. 潘雪凯, 苏飞, 蔡小鹏, 等. 坏死性筋膜炎的诊治现状. 中华临床医师杂志(电子版), 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. 李大伟, 赵刚, 唐宇峰, 等. 多学科联合治疗多发伤合并坏死性筋膜炎7例体会. 创伤外科杂志, 2018, 20(9): 647-650.
27. 孙广峰, 王达利, 魏在荣, 等. 皮片游离移植修复阴囊撕脱伤对精子生成影响的实验研究及临床观察. 中华外科杂志, 2012, 50(1): 45-48.
28. 李笑眉, 罗艺, 康雨龙, 等. 浸浴疗法结合红蓝光照射治疗肛周大面积坏死性筋膜炎多切口引流术后一例. 中华损伤与修复杂志(电子版), 2019, 14(6): 475-476.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

9 例肛周会阴部坏死性筋膜炎的诊断和治疗分析

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