Fournier坏疽进展及治疗转归——基于15例患者病例分析  

Progression,treatment,and prognosis of Fournier’s gangrene——based on a case study of 15 patients

作　　者：姜华 张聂珂 陈恕求 许斌[1,2] 邢利 张力杰[1,2] 柳靖 朱伟东 陈明 Jiang Hua;Zhang Nieke;Chen Shuqiu;Xu Bin;Xing Li;Zhang Lijie;Liu Jing;Zhu Weidong;Chen Ming(Urology Department,Zhongda Hospital,Southeast University,Nanjing 210009,China;School of Medicine,Southeast University)

机构地区：[1]东南大学附属中大医院泌尿外科,南京210009 [2]东南大学医学院

出　　处：《中国男科学杂志》2021年第6期83-87,共5页Chinese Journal of Andrology

基　　金：国家自然科学基金项目资助(82070773)。

摘　　要：目的分析Fournier坏疽的起病特点以及病程进展,总结其临床症状及实验室和影像学表现,探究其诊断及治疗方案的选择。方法回顾性分析本研究中心15例确诊为Fournier坏疽的病例,总结并对比其发病情况、疾病进展过程、治疗方案、临床症状、实验室影像学检查结果和转归预后。结果13例患者治愈出院,治愈率86.67%,1例患者死亡,1例患者拒绝继续治疗自动出院。3例患者行阴茎植皮术,8例行阴囊成形术。1例患者行阴囊切开引流术及右侧腰背部切开引流术,后行Ⅱ期手术并逐渐拔除部分引流。2例患者行阴囊扩大清创术及肛周脓肿切开引流术,后予以每日双氧水冲洗换药并逐步拔除引流。接受阴茎或阴囊植皮的患者中有8例植皮术后手术切口Ⅰ期愈合,余3例患者植皮手术区域出现感染、坏死及渗液,经每日换药及冲洗消毒后达到Ⅱ、Ⅲ期愈合。结论Fournier坏疽起病急,进展快,早诊断、早治疗是关键,早期应予以彻底清创引流,外科手术结合封闭式负压吸引、高压氧等综合治疗方案可提高患者治愈率。Objective To discuss diagnosis and treatment of Fournier’s gangrene by analyzing the pathogenesis and progression of this disease,and summarizing its clinical symptoms,laboratory and imaging manifestations.Methods A retrospective analysis was performed on 15 patients diagnosed with Fournier’s gangrene in our research center,and the incidence,progression,treatment plan,clinical symptoms,laboratory imaging results and prognosis were summarized and compared.Results Of all these patients,13 patients were cured,1 patient died,and 1 patient refused to continue treatment and was discharged automatically.The total cure rate was 86.67%.Three patients underwent penile skin grafting and eight underwent scrotoplasty.One patient underwent scrotal incision and drainage as well as the incision and drainage surgery on the right lumbar and back.After that,the right lumbar wound healed well,and stage II surgery was performed and part of drainage was gradually removed.Two patients underwent incision and drainage of perianal abscess at the same time as extended scrotal debridement,followed by daily flushing with hydrogen peroxide and gradual removal of drainage tube.Among the patients receiving penile or scrotal skin grafting,8 patients had stage I healing after skin grafting,while the other 3 patients had infection,necrosis and exudation in the area of skin grafting,which reached stage II and III healing after daily dressing change,washing and disinfection.Conclusion Fournier’s gangrene is a disease with acute onset and rapid progression.Early diagnosis and treatment are very important.Thorough detrauma and drainage should be carried out in the early stage.Surgical operation combined with vacuum sealing drainage and hyperbaric oxygen can improve the cure rate of patients.

关 键 词：FOURNIER坏疽 诊断 病因 治疗 

分 类 号：R634[医药卫生—外科学] R697.16[医药卫生—临床医学]