- 期刊
Evaluation of Fournier Gangrene and Stoma Intervention
佛尼爾氏壞疽與大腸造口介入之評估
摘要
Purpose. Fournier gangrene (FG) is a form of necrotizing fasciitis that occurs simultaneously in the perianal, perineal, or genital area; causes embolism of the subcutaneous small blood vessels; and develops into gangrene of the overlying skin. Its associated high mortality rate, prolonged hospitalization, and medical costs have been of concern for physicians. This study aimed to evaluate the effect of stoma creation on the mortality rate and duration of hospitalization of patients with FG. Methods. We retrospectively enrolled 46 patients diagnosed with FG at our hospital between 1998 and 2018. The data collected included the patient characteristics, clinical parameters, operative factors, postoperative factors, length of hospital stay, and mortality rate. The patients were grouped into two for analysis based on the presence or absence of a stoma. Results. The patients with a stoma had shorter hospitalization stays than those without (p = 0.044). Among the patients with postoperative wound diameters less than 20 cm, those with a stoma had longer hospitalization stays than those without (p = 0.001). However, for patients with postoperative wound diameters larger than 20 cm, those who had a stoma had significantly shorter hospital stays than those without (p = 0.039). Conclusion. We inferred that a higher proportion of patients with stoma had hospital stays exceeding 30 days than those without. Patients with stomas showed a trend for increased mortality, which was not significant due to the low death count. Milder FG results in smaller wound diameter, a lower rate of stoma creation, and shorter hospitalization stays.
並列摘要
前言：佛尼爾氏壞疽（FG）是一種壞死性筋膜炎，同時發生在肛周、會陰或生殖器區域，導致皮下小血管栓塞，並發展為上覆皮膚的壞疽。幾十年來，高死亡率、延長住院時間和與之相關的醫療費用一直困擾著醫生。本研究旨在評估造口對佛尼爾氏壞疽患者死亡率和住院時間的影響。方法：我們回顧性納入了1998年至2018年間在我院診斷為FG的46例患者。根據他們是否接受造口進行分析，將患者分為兩組。結果：有造口的患者的住院時間明顯短於沒有造口的患者（p=0.044）。兩組在性別、年齡、傷口直徑、住院科、Fournier壞疽嚴重程度指數（FGSI）、死亡率、手術次數和實驗室參數（包括C反應蛋白、白細胞）等方面均無顯著差異計數、中性粒細胞－淋巴細胞比率和糖基化血紅蛋白。亞組分析顯示，術後傷口直徑小於20cm的患者中，有造口的患者住院時間比沒有造口的患者長（p=0.001）。然而，在術後傷口直徑大於20cm的患者中，有造口的患者住院時間明顯短於沒有造口的患者（p=0.039）。結論：我們推論患有造口的病患，其住院時間超過30天的比例較高，相較於沒有造口的病患。具有造口的患者呈現死亡率上升的趨勢，但由於死亡數量較低，這種趨勢並不具統計學意義。FG病情較輕會導致較小的傷口直徑，造口率較低，且住院天數較短。