Fournier坏疽创面感染控制策略及创面修复的临床分析  

Clinical analysis of Fournier gangrene wound infection control strategy and wound repair

作　　者：崔子豪 阳跃 赵景峰 冯光 庹晓晔 Zihao Cui;Yue Yang;Jingfeng Zhao;Guang Feng;Xiaoye Tuo(Department of Repair and Reconstructive Surgery,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]北京大学首钢医院修复重建外科,100144

出　　处：《中华损伤与修复杂志（电子版）》2024年第4期319-323,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的:探讨Fournier坏疽(FG)的临床特征、创面感染控制策略及创面修复方式。方法:回顾性分析2022年3月至2023年6月于北京大学首钢医院修复重建外科收治确诊为FG的患者10例,所有患者均在入院24 h内行清创手术,并予以静脉广谱抗生素联合全身对症支持治疗。分析患者疾病临床特点、感染控制方案及创面修复方式。随访观察患者修复区外观及功能,并统计复发率。结果:通过纳入、排除标准,共10例患者入组,均为男性(100%);平均年龄67.1(27~85)岁;平均住院时间为73.8(18~93)d。最常见的诱发因素是2型糖尿病。主要采用直接缝合和游离植皮的方式进行创面修复重建手术。除1例患者因疾病恶化,全身性感染死亡外,其余患者随访资料完整,并进行了平均2.4(1~4)次清创手术。额外的手术干预有:结肠造瘘手术(8/9),睾丸切除手术(1/9)。随访时间6~12个月。随访结果显示患者创面均愈合良好,无复发病例。结论:早期对疾病的诊断、广泛的清创以及及时、充分的全身抗感染治疗是FG治疗的核心,同时也是降低患者复发率和病死率的关键。考虑到FG患者的特殊性,创面修复重建手术需把握个性化与需求主次的平衡原则,选择合适的修复方式。Objective To investigate the clinical characteristics,wound infection control strategies,and wound repair methods of Fournier gangrene.Methods A retrospective analysis was conducted on 10 patients diagnosed with Fournier's gangrene admitted to the Department of Repair and Reconstruction Surgery in Peking University Shougang Hospital from March 2022 to June 2023.All patients underwent debridement surgery within 24 hours of admission and received intravenous broad-spectrum antibiotics and systemic symptomatic support treatment.The clinical characteristics of the disease,infection control plans,and wound repair methods were analyzed.Results A total of 10 patients with Fournier's gangrene were enrolled.All patients were males(100%)with an average age of 67.1(27~85)years old;The average length of hospital stay was 73.8(18~93)days.The most common inducing factor was type 2 diabetes.Except for one patient who died of systemic infection due to disease deterioration,all other patients underwent 2.4 debridement surgeries(1~4).Several additional surgical interventions were performed:colostomy surgery(8/9),and testicular resection surgery(1/9).The main methods of wound repair and reconstruction were direct suturing or free skin grafting.Nine patients were followed up for 6-12 months,and all wounds healed well without recurrence.Conclusion Early identification of diseases,extensive debridement,and timely and adequate systemic anti-infection treatment are the core of Fournier′s gangrene treatment,as well as the key to reduce the recurrence rate and mortality.Considering the particularity of Fournier gangrene patients,the principle of balancing personalized operation needs and priorities should be applied in wound repair and reconstruction surgery,and appropriate repair methods should be selected.

关 键 词：FOURNIER坏疽 感染控制个性化 创面修复重建 回顾性研究 

分 类 号：R622[医药卫生—整形外科]