坏死性筋膜炎的临床特征及综合治疗  

Clinical features and synthetical treatment of necrotizing fasciitis

作　　者：蔡人杰 杨长煌 郑德义 王宝云[2] 杜娇[2] Cai Renjie;Yang Changhuang;Zheng Deyi;Wang Baoyun;Du Jiao(School of Clinical Medicine,Guizhou Medical University,Guizhou Guiyang 550004,China;Department of Burns and Plastic Surgery,Guizhou Provincial People’s Hospital,Guizhou Guiyang 550499,China)

机构地区：[1]贵州医科大学临床医学院,贵州贵阳550004 [2]贵州省人民医院烧伤整形外科,贵州贵阳550499

出　　处：《遵义医科大学学报》2023年第8期771-776,共6页Journal of Zunyi Medical University

基　　金：国家自然科学基金资助项目(NO:81760021)。

摘　　要：目的探讨坏死性筋膜炎(NF)的临床特点及治疗方法。方法回顾分析我科近年来收治的17例坏死性筋膜炎患者临床资料,并总结相关临床特征、治疗方法及效果。结果17例NF患者中男11例、女6例,年龄(55±15)岁(15~76岁);合并基础疾病15例,其中糖尿病6例;明确及疑似长期服用糖皮质激素5例;发病部位以下肢为主(10例),其次会阴、阴囊及下腹部;发生并发症12例,其中肺部感染9例,脓毒症及MODS 4例;分泌物细菌培养主要是大肠埃希菌。手术方式有切开扩创、负压封闭引流(VSD)、植皮及皮瓣转移,13例患者行VSD负压引流,11例经植皮、皮瓣移植修复皮肤缺损。治愈12例,好转出院5例,住院时间(38.1±22.2)d。结论坏死性筋膜炎的患者多伴有基础疾病,应早期手术扩创及负压引流,结合抗生素、营养支持等及基础疾病、并发症的内科治疗,植皮、皮瓣转移修复皮肤缺损创面。Objective To investigate the clinical characteristics and treatment methods of necrotizing fasciitis(NF).Methods We retrospectively analyzed the clinical data of 17 patients with NF admitted to our department in recent years,and summarized the relevant clinical features,treatment methods and effects.Results Among the 17 patients with NF,11 were male and 6 were female,aged(55±15)years(15-76 years old);15 had combined underlying diseases,including 6 cases of diabetes mellitus and 5 cases of definite and suspected long-term glucocorticoid use;the onset of the disease was mainly in the lower extremities(10 cases),followed by the perineum,scrotum and lower abdomen;12 cases had complications,including 9 cases of pulmonary infection,4 cases of sepsis and MODS;The bacterial culture showed mainly Escherichia coli.The surgical procedures included incision and dilation,negative pressure closed drainage(VSD),skin grafting and flap transfer.13 patients underwent VSD negative pressure drainage,and 11 had skin defects repaired by skin grafting and flap transfer.Twelve cases were cured and five cases were discharged in good condition,with a hospital stay of(38.1±22.2)days.Conclusion Patients with necrotizing fasciitis are mostly accompanied by underlying diseases,emphasizing the importance of early surgical dilation and negative pressure drainage,combined with antibiotics,nutritional support,etc.and medical treatment of underlying diseases and complications,and the repair of skin defect wounds by skin grafting and flap transfer.

关 键 词：坏死性筋膜炎 负压封闭引流 植皮 皮瓣转移 

分 类 号：R622[医药卫生—整形外科]