基于保留皮肤的“防火带”式引流术治疗肛周坏死性筋膜炎  

Treatment of Fournier's gangrene with"firebreak"drainage based on skin preservation

作　　者：叶晓瑞[1] 金黑鹰[1] 王俊[1] 张春霞[1] 杨阳[1] 顾家博 张心怡 刘建磊 沈彬艳 Ye Xiaorui;Jin Heiying;Wang Jun;Zhang Chunxia;Yang Yang;Gu Jiabo;Zhang Xinyi;Liu Jianlei;Shen Binyan(Department of AnoRectal Surgery,the Second Affiliated Hospital of Nanjing University of TCM,Nanjing 210017,China)

机构地区：[1]南京中医药大学第二附属医院肛肠科,南京210017

出　　处：《中华胃肠外科杂志》2024年第7期726-730,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省中医药科技发展计划面上项目(MS2023047);江苏省第二中医院院内课题一般项目(SEZYB2023001)。

摘　　要：目的观察应用一种新型保留皮肤的“防火带”式引流术治疗肛周坏死性筋膜炎的临床疗效。方法本技术适用于就诊时未发生大面积皮肤发黑坏死、可耐受手术的肛周坏死性筋膜炎患者。手术步骤及要点:(1)根据影像学检查及术中探查,确定炎性组织和正常组织的分界线;(2)沿脓肿波动感最明显的部位切开脓腔,长径3~4 cm,短径1~2 cm;(3)从主切口向感染外缘潜行分离清理坏死组织,每分离3~5 cm作一梭形切口,长径2~3 cm,短径约1 cm,潜行分离直至正常组织处,各相邻切口间挂软管对口引流;(4)各相邻边缘切口间均作潜行分离并挂软管引流,形成“防火带”;(5)反复冲洗创面;(6)如果感染侵及直肠,酌情行结肠造口。回顾性分析2019年7月至2023年2月南京中医药大学第二附属医院收治的11例肛周坏死性筋膜炎患者的病例资料,所有患者均采用保留皮肤的“防火带”式引流术进行了急诊手术清创治疗。结果11例全部治愈,治愈率100%。1例行多次手术。平均住院时间22(11~46)d,平均创面愈合时间43(28~75)d。除了1例外伤患者,其余患者术后均无明显肛门功能损伤,11例患者均痊愈出院,术后中位随访136(115~413)d,无复发。结论基于保留皮肤的“防火带”式引流术治疗肛周坏死性筋膜炎具有创伤小,恢复快等优势,且不造成明显肛门功能损伤。Objective To observe the clinical efficacy of a new type of"firebreak"drainage with skin preservation in the treatment of Fournier's gangrene.Methods This technique is suitable for patients with perianal necrotizing fasciitis who can tolerate surgery without large area of skin blackness and necrosis.Procedure and key points:(1)The dividing line between inflammatory tissue and normal tissue was determined according to imaging examination and intraoperative exploration;(2)The abscess cavity was cut along the most obvious part of the abscess fluctuation,with a long diameter of 3~4 cm and a short diameter of 1~2 cm;(3)Necrotic tissue was discreetly separated and removed from the main incision to the outer edge of the infection.A fusiform incision was made every 3 to 5 cm,with a long diameter of 2 to 3 cm and a short diameter of 1 cm,and discreetly separated until the normal tissue,and a hose was hung between the adjacent incisions for drainage.(4)Each adjacent edge cut between the stealth separation and hanging hose drainage,forming a"firebreak";(5)Rinse the wound repeatedly;(6)If the infection invades the rectum,colostomy is performed as required.The case data of 11 patients with perianal necrotizing fasciitis admitted to the Second Affiliated Hospital of Nanjing University of Chinese Medicine from July 2019 to February 2023 were retrospectively analyzed.All patients were treated with emergency surgical debridement by"firebreak"drainage with skin preservation.Results All 11 cases were cured with 100%.One case underwent multiple operations.The hospitalization time was 11-46 days,with an average of 22 days.The wound healing time was 28-75 days,with an average of 43 days.Except for 1 patient with trauma,all the other patients had no significant anal function injury after surgery.All the 11 patients recovered and were discharged from hospital with a median follow-up of 136(115-413)days.Conclusions The"firebreak"drainage based on skin preservation has the advantages of less trauma and faster recovery,and do not cause obv

关 键 词：肛周坏死性筋膜炎 防火带 保留皮肤 临床疗效 

分 类 号：R657.1[医药卫生—外科学]