Fournier's Gangrene: A Retrospective Clinical Study in a Single Institution

弗尼爾氏壞疽：我們的經驗和目前的做法－一個來自單一機構的回顧性臨床研究

周家麟(Chia-Lin Cho) ； 翁世峰(Shih-Feng Weng) ； 牛柯琪(Ko-Chi Niu) ； 鄭立勤(Li-Chin Cheng) ； 田宇峯(Yu-Feng Tian) ； 洪明蟬(Ming-Chran Hung)

《中華民國大腸直腸外科醫學會雜誌》 26卷3期 (2015/09) Pp. 77-85

https://doi.org/10.6312/SCRSTW.2015.26(3).10335

摘要

目的　弗尼爾氏壞疽是一種猛爆性的壞死性筋膜炎，牽涉到生殖器，肛周及會陰部的區域，並與迅速蔓延的嚴重敗血症相關。為了研究弗尼爾氏壞疽的表現，治療方法和總死亡率，我們從一個單一機構提出回顧性的研究。方法　蒐集從2007年1月至2012年12月出院診斷為弗尼爾氏壞疽的患者。關於病患的特徵，病史，臨床表現，入院實驗檢查，治療方式，住院天數和結果進行分析。結果　總共有60名弗尼爾氏壞疽的病患，其中包含49例男性，11例女性，他們的平均年齡為58.2 ± 14.2歲（範圍：29－88）。總死亡率為21.67%（13例）。在這些患者中，46例接受手術清創和抗生素治療，其餘14例接受手術清創、抗生素治療和高壓氧治療。腸造口在存活組與非存活組並無統計學上顯著差異（p = 0.421）。年老（≧75歲）和敗血性休克是弗尼爾氏壞疽的獨立預後因素。腸造口並沒有影響敗血性休克患者的死亡率（42.86% 比55.56%，p = 0.680）。高壓氧治療可以降低弗尼爾氏壞疽死亡率（0.0% 比28.26%，p = 0.027），包括敗血性休克的病人（0.0% 比73.33%，p = 0.001）。結論　這些結果並不支持對於弗尼爾氏壞疽病患，給予常規腸造口手術。然而，高壓氧治療對弗尼爾氏壞疽患者有生存上的助益。

關鍵字

弗尼爾氏壞疽 ； 筋膜炎 ； 清創 ； 高壓氧治療

並列摘要

Purpose. Fournier's gangrene is a fulminant necrotizing fasciitis, which affects the genital, perianal, and perineal regions. We present a retrospective analysis of the clinical presentation, treatment modalities, and overall mortality of Fournier's gangrene in a single institution. Methods. Records of patients diagnosed with Fournier's gangrene between January 2007 and December 2012 were reviewed. Data on the demographics, medical history, clinical presentation, laboratory studies, treatment modality, duration of hospital stay, and clinical outcomes were analyzed. Results. Atotal of 60 patients (49 males and 11 females) with a mean age of 58.2 14.2 years were identified. The mortality rate was 21.7% (13 cases). Of the 60 patients, 46 underwent surgical debridement and antibiotic therapy, whereas 14 were treated with hyperbaric oxygen (HBO) therapy, surgery, and antibiotics. There was no statistically significant difference in the use of diversion stoma between the survival and non-survival groups (p = 0.421). Old age and septic shock were independent prognostic factors of Fournier's gangrene. Diversion stoma had no influence on the mortality rate of patients with septic shock (42.9% vs. 55.6% with and without stoma, respectively; p = 0.680). However, HBO therapy decreased the mortality rate in patients with septic shock (0.0% vs. 73.3% with and without HBO therapy, respectively; p = 0.001), and in all patients with Fournier's gangrene (0.0% vs. 28.3% with and without HBO therapy, respectively; p = 0.027). Conclusions. These data do not support the routine use of diversion stoma in Fournier's gangrene. HBO therapy appears to provide a survival benefit to these patients.

並列關鍵字

Fournier's gangrene ； Fasciitis ； Debridement ； Hyperbaric oxygen therapy

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