腹壁坏死性筋膜炎的认识与治疗  

Recognition and treatment of abdominal wall necrotizing fasciitis

作　　者：王革非 任建安 黎介寿 WANG Ge-fei;REN Jian-an;LI Jieshou(The First School of Clinical Medicine,Southern Medical University and Clinical School of NanjingUniversity,Department of General Surgery,Jinling Hospital,Nanjing 210002,China)

机构地区：[1]南方医科大学第一临床医学院及南京大学医学院附属金陵医院普通外科,江苏南京210002

出　　处：《中国实用外科杂志》2022年第8期936-939,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.81870396,No.82170581);军队后勤科研面上项目(No.CLB20J020);江苏省自然科学基金面上项目(No.BK20211133)。

摘　　要：坏死性筋膜炎是皮肤软组织感染中最为凶险的类型,往往并发脓毒症休克和多器官功能障碍,死亡率较高。常见的坏死性筋膜炎是社区获得性感染,而临床上发生在腹壁的坏死性筋膜炎也并不罕见,如发生于经皮内镜胃造口管或者造口周围的坏死性筋膜炎,也有发生于整形手术、妇科手术、结直肠手术后的坏死性筋膜炎。腹部手术后发生消化道瘘并发腹壁坏死性筋膜炎,病死率高,值得重视。尽早诊断与及时实施包括坏死组织清除、消化道瘘引流以及腹腔开放在内的感染源控制措施至关重要。Necrotizing fasciitis is the most serious type of skin and soft-tissue infection, accompanied by septic shock and multiple organ dysfunction frequently, and causes a high mortality rate. The common necrotizing fasciitis is usually community-acquired infection, but in clinical, iatrogenic necrotizing fasciitis is not rare, such as NF occurred around the tuber of percutaneous endoscopic gastrostomy or stoma,and there were reports about postoperative NF after plastic surgery, gynecologic surgery, and colorectal surgery. The mortality rate of postoperative gastrointestinal fistula complicated with necrotizing fasciitis especially after operation for severe abdominal trauma was high, early diagnosis and timely source control measures including removal of fascial necrotic tissue, drainage of gastrointestinal fistula and open abdomen therapy are key factors.

关 键 词：坏死性筋膜炎 皮肤软组织感染 腹壁 消化道瘘 腹腔开放 

分 类 号：R6[医药卫生—外科学]