急性坏死性筋膜炎诊治体会  

Diagnosis and management of necrotizing fasciitis： a report of 24 eases

作　　者：汪颖厚[1] 辛世杰[1] 杨栋[1] 苗鹏[2] 李晰[1] 王磊[1] 张健[1] 段志泉[1] 

机构地区：[1]中国医科大学附属第一医院普通外科教研室血管甲状腺外科,沈阳110001 [2]中国医科大学附属第一医院普通外科教研室肛肠外科,沈阳110001

出　　处：《中华普通外科杂志》2013年第4期270-272,共3页Chinese Journal of General Surgery

摘　　要：目的总结坏死性筋膜炎（necrotizing fasciitis，NF）的临床诊断和治疗经验。方法回顾性分析中国医科大学附属第一医院2006--2012年24例坏死性筋膜炎的临床资料，并总结诊治体会。结果本组24例坏死性筋膜炎患者，其中男19例，女5例；年龄25～72岁，平均年龄（54±12）岁。发病部位：会阴部、臀部16例，左下肢3例，背部2例，右下肢2例，右下肢及左背部1例。治疗方法：24例均采取广泛切开引流、彻底清创及有效的抗生素治疗，其中输白蛋白13例，输血9例，应用肠外营养19例，接受高压氧治疗15例。24例中一期治愈17例（70．83％），二期植皮4例（16．67％），复发2例（8．33％），死亡1例（4．17％）。结论坏死性筋膜炎起病较急，进展迅速，必须尽早确诊，给予有效抗生素治疗的同时强调早期切开引流、彻底清创，并要加强临床护理及相关营养等支持疗法。Objective To study the clinical diagnosis and treatment of necrotizing fasciitis. Methods We retrospectively analyzed the clinical data of 24 necrotizing fasciitis cases between 2006 and 2012. Results There were 24 necrotizing fasciitis patients, including 19 men and 5 women, aging from 25 to 72 years （mean = 54. 3 years）. Main pathological process started in perineum and buttock in 16 patients, in left lower extremity in 3 patients, in back in 2 patients, in right lower extremity in 2 patients, and in right lower extremity and back in one. Extensive incision and drainage was achieved in 24 patients combined with debridement and effective antibiotic therapy. Albumin was given in 13 patients, 9 patients received blood transfusion, 19 patients received parenteral nutrition support and 15 patients received hyperbaric oxygen treatment. 17 patients （70. 83% ） were cured primary stage, 4 patients （16. 67% ）received skin graft, 2 patients （8.33%） relapsed and 1 patient（4. 17% ） died. Conclusions Necrotizing fasciitis which is acute and progressing rapidly needs to be diagnosed and treated at an early stage. We emphasize on drainage and debridement thoroughly, and we use antibiotics combined with clinical care and nutrition support therapy.

关 键 词：筋膜炎 坏死性 清创术 抗炎 

分 类 号：R6[医药卫生—外科学]