暴发性阴囊坏疽治疗9例体会

目的：探讨暴发性阴囊坏疽的治疗方法。方法：对9例患者均行外科清创、冲洗引流、抗感染等治疗，其中3例外暴露的睾丸暂置于浅表腔隙中，二期重建阴囊回纳睾丸，1例患者行高压氧治疗。结果：留置U形管引流者，重复清创手术的次数明显减少，体温及血常规恢复正常的时间较普通引流显著缩短，术后恢复迅速。结论：暴发性阴囊坏疽的治疗仍以清创及应用抗生素为主，术中多无须切除睾丸；条件许可，可配合高压氧治疗；U形多孔双向引流管在清创术后引流效果确切，对促进康复有明显优势。

Management of Fournier's gangrene(Report of 9 cases)

Purpose: To study the management of Fournier's gangrene. Methods; Nine patients were reviewed retrospectively and discussed according to the treatment and outcome. Results: We have treated 9 cases in the last 11 years.The patients received surgical treatment including incisions, aggressive debridement, drainage, irrigation, and antibiotic therapy. Three cases left uncovered and the testes were protected in either a thigh or abdominal wall pouch and back in the scrotum resconstructed later with a myocutaneous medial thigh flap. One patient received hyperbaric oxygen therapy. When U-shaped stents was used, there need not redunant debriding and the effect in temperature and blood regained significantly. Conclusions: Aggressive debridement and broad-spectrum antibiotics remain the hallmarks of treatment. Orchidectomy was erroneously part of the treatment of Fournier's gangrene. Hyperbaric oxygen is also an adjunct in the treatment. The remarkable draining effect of U-shaped stents would promote tissue healing.