Fournier坏疽的CT表现和诊断  

CT features and diagnosis of Fournier′s gangrene

作　　者：梁惠康 袁佳欣 周玉祥[3] 云惟健 曾裕镜[3] 彭洋 关键[2] 张繁 LIANG Hui-kang;YUAN Jia-xin;ZHOU Yu-xiang(Department of Radiology,Boluo County People's Hospital,Guangdong 516100,China)

机构地区：[1]博罗县人民医院放射科,广东516100 [2]中山大学附属第一医院放射科,广州510080 [3]惠州市中心人民医院放射科,广东516001

出　　处：《放射学实践》2025年第1期61-66,共6页Radiologic Practice

基　　金：广东省基础与应用基础研究基金(No.2024A1515012098);广州市科技计划项目(2023A04J2228)。

摘　　要：目的:探讨Fournier坏疽的CT表现,提高对Fournier坏疽的认识及诊断水平。方法:回顾性分析确诊为Fournier坏疽的16例患者的临床及CT影像资料。所有患者均经手术证实,并行病原学检测。11例行CT盆腹腔平扫,5例盆腹腔CT平扫及增强扫描;治疗后13例进行CT复查。结果:16例患者中男13例,女3例,年龄36~76岁,中位年龄57.5岁。16例中14例存在一种或多种基础疾病(包括糖尿病、慢性肾衰竭、贫血或低蛋白血症等)。所有病例均表现为不同程度的会阴部红肿、严重疼痛。MSCT表现为:(1)会阴部深筋膜表面及肌间隙积气伴坏死物15例;可累及臀部、腹股沟区、腹壁,1例蔓延至腹膜后间隙;(2)广泛深筋膜或肌肉不对称增厚、水肿10例,5例增强扫描筋膜均呈不均匀强化;(3)局限性积液、脓肿形成6例;(4)皮下软组织肿胀16例。病例转归:13例好转出院,其中10例复查CT均表现为深筋膜、皮下软组织肿胀减轻,坏死灶、脓肿吸收;3例进展最终死亡,复查CT表现为深筋膜、肌肉坏死范围持续扩大。结论:Fournier坏疽以会阴部积气和筋膜炎为特征性CT表现,多见于免疫力下降的中老年男性患者。CT可准确判断病变的范围和累及深度,有助于诊断及疗效评估。Objective:To explore the CT features of Fournier gangrene in order to enhance the understanding and diagnosis of this disease.Methods:We conducted a retrospective analysis of clinical and CT imaging data from 16 patients diagnosed with Fournier′s gangrene.All patients were confirmed to have the disease through surgical and etiological testing.Eleven patients underwent non-enhanced CT scans of the abdomen and pelvis,while the remaining five patients underwent non-enhanced and enhanced CT scans.In addition,CT scans were repeated in 13 patients after treatment.Results:The patient group consisted of 13 men and 3 women,aged between 36~76 years with an average age of 57.5 years.Among them,14 patients had one or more underlying diseases such as diabetes,chronic renal failure,anemia,or hypoproteinemia.All patients experienced perineal swelling and severe pain,with varying degrees of intensity.The manifestations of CT were as follows:①Pneumatosis was observed on the surface of the perineal deep fascia and muscle space with necrosis present in 15 cases,affecting the buttocks,groin region,and even spreading to the abdominal wall,while in one case it spread to the retroperitoneal space;②Out of the total cases,10 had extensive deep fascia or muscle asymmetrical thickening and edema,whereas 5 cases showed uneven enhancement on the enhanced CT scan.③In 6 cases,localized effusion and abscess formation were observed.④Subcutaneous soft tissue swelling was observed in all 16 cases.After treatment,13 patients were discharged with significant improvement,out of which 10 cases showed a reduction in deep fascia and subcutaneous soft tissue swelling and complete absorption of necrosis and abscesses.However,3 cases showed progression and eventually resulted in death.Upon CT reexamination,it was observed that the area of deep fascia and muscle necrosis continued to expand in these cases.Conclusion:Fournier gangrene is characterized by the presence of perineal pneumatosis and fasciitis,which can be identified through CT imaging.T

关 键 词：FOURNIER坏疽 会阴部 感染 筋膜炎 体层摄影术 X线计算机 

分 类 号：R634[医药卫生—外科学] R814.42[医药卫生—临床医学]