中西医结合治疗急性肛周坏死性筋膜炎21例

目的:探讨肛周坏死性筋膜炎的中西医结合治疗方案、疗效及转归。方法:以2015年4月—2018年5月在我院治疗的21例坏死性筋膜炎作为研究对象,回顾性分析临床表现、实验室和影像学检查、中西医结合诊治方案及转归。结果:肛周坏死性筋膜炎主要症状和体征包括患处红肿、剧烈疼痛、皮肤脓性水疱或坏死、伴有恶臭味、体温升高、感染指标和血糖水平上升、白蛋白水平下降。影像学表现为病灶软组织肿胀和筋膜间隙气泡影。术中可见筋膜组织广泛坏死、色黑、脓液从筋膜组织里渗出,伴明显恶臭味。术后切口多、创面深大,需持续双氧水冲洗,联合使用广谱抗生素、持续吸氧、营养支持、切口每日冲洗换药、中医药托毒排脓去腐生肌等综合治疗,直至感染控制、创面肉芽组织转红、创面愈合。21例患者均治愈,治愈率100%,半年随访确认无术后致残。结论:肛周坏死性筋膜炎容易被误诊延误治疗,一旦确诊需急诊手术切开扩创引流,清除所有坏死组织。术后中西医结合综合治疗,可尽早控制感染,促进创面愈合,提高治愈率,降低术后致残率。

21 Cases of Acute Perianal Necrotizing Fasciitis Treatment with Traditional Chinese and Western Medicine

Objective:To investigate the treatment of perianal necrotizing fasciitis with the combination of Traditional Chinese and Western Medicine,the curative effect and the outcome.Methods:21 cases of necrotizing fasciitis from April 2015 to May 2018in our hospital were taken as the research objects,and the clinical manifestations,laboratory and imaging examination,diagnosis and treatment scheme of integrated of Traditional Chinese and Western Medicine and their outcomes were retrospectively analyzed.Results:The main symptoms and signs of perianal necrotizing fasciitis included redness and swelling,severe pain,pustular or necrotic skin,fetid odor,elevated body temperature,increased infection index and blood glucose level,and decreased albumin level.The imaging findings were soft tissue swelling and air bubble between fascia.During the operation,extensive necrosis of the fascia tissue was seen,with dark color.Pus exuded from the fascia tissue,accompanied by obvious foul smell.After the combined operation of Traditional Chinese and Western Medicine,there were many incisions and deep wounds,which need to be washed with hydrogen peroxide continuously,and the comprehensive treatment including broad-spectrum antibiotics,continuous oxygen inhalation,nutritional support,daily washing and dressing change of incisions,and Traditional Chinese medicine for detoxification,purulent discharge,putrefaction and muscle regeneration,until infection control,granulation tissue turning red and wound healing.21 cases were cured,the cure rate was 100%,and no postoperative disability half a year follow-up.Conclusion:Perianal necrotizing fasciitis is easy to be misdiagnosed and delayed for treatment.Once diagnosed,it requires emergency surgery for incision,expansion and drainage to remove all necrotic tissues.The comprehensive treatment of integrated Traditional Chinese and Western Medicine after operation can control infection as early as possible,promote wound healing,improve the cure rate and reduce the disability rate.