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。     

阴囊坏疽的治疗体会(附14例报告)

目的总结阴囊坏疽的治疗方法。方法2003年8月至2005年6月诊治阴囊坏疽14例，患者年龄27～74岁，平均48岁。阴囊坏疽并发肛周、阴茎坏疽者2例，并发肛周、阴茎、腹股沟区坏疽者10例，并发肛周、阴茎、腹股沟区、腹部皮下坏疽者2例。其中并发阴茎坏死3例，并发睾丸炎5例。14例细菌培养均为阳性。14例均采用Ⅰ期清创、阴囊成形、置管引流术，同时给予抗炎对症治疗。3例阴茎坏死者行阴茎全切、尿道造瘘术，2例腹部坏疽者行腹部皮下切开清创引流，5例睾丸炎者行单侧睾丸切除。结果12例阴囊成形术Ⅰ期愈合，2例尿道造瘘术患者痊愈出院。10例阴茎皮肤坏疽者1个月后阴茎植皮，痊愈出院。死亡2例。结论早期及时清创和抗炎对症治疗是治疗本病的关键，Ⅰ期清创、阴囊成形及置管引流是治疗阴囊坏疽的有效方法。     

暴发性阴囊坏疽的局部处理方法探讨

目的 探索暴发性阴囊坏疽的治疗方法。方法 回顾分析9例暴发性阴囊坏疽治疗方案。9例患者均行外科清创，冲洗引流，抗感染等治疗，其中4例感染广泛蔓延的患者清创术后，采用U形多孔双向引流管引流。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。结果 留置U形管引流者，重复清创手术的次数明显减少，体温及血象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，术中多毋须切除睾丸。U形多孔双向引流管在清创术后引流效果确切，在促进康复有明显优势。     

感染性阴囊缺损修复重建临床体会

目的:探索感染性阴囊缺损的修复方法。方法:选择2008年1月-2014年5月间南阳南石医院烧伤整形科收治阴囊坏疽4例,均采用早期清创+封闭负压引流+股薄肌岛状皮瓣转移模式修复。早期清创,清除坏死组织,保留精索及睾丸,应用封闭负压引流技术(vacuum sealing drainage,VSD),控制感染,促进肉芽组织生长,创面清洁后应用股薄肌岛状皮瓣转移对感染性阴囊缺损行阴囊重建。记录伤口愈合等级,依生活满意度标准对生活满意度打分,记录伤口愈合时间。对手术前、手术后3月生活质量进行评分。结果:4例阴囊坏疽股薄肌岛状皮瓣转移术后全部愈合,3例甲级愈合,1例乙级愈合。其中1例合并耐药金黄色葡萄球菌感染,经应用替考拉宁针静滴及创面换药后愈合。4例均保留了睾丸,又再造了阴囊,外形皮肤色。满意度评分:3例非常满意,1例大体满意,原因自觉阴囊非原始阴囊有自卑感。住院时间24~36d,平均28.5d。术后生活质量明显提高(P0.05)。术前、术后3个月在身体受限程度、躯体疼痛、综合健康、活力评分、社交功能、情感受限、心理健康等方面差异有统计学意义(P0.05)。结论:早期清创应用封闭负压引流技术后联合股薄肌岛状皮瓣转移是感染性阴囊缺损阴囊重建的良好方法。     

封闭式负压引流技术辅助治疗阴茎、阴囊坏疽4例临床分析

目的:通过分析总结封闭式负压引流技术辅助治疗阴茎、阴囊坏疽的临床疗效,探讨该类疾病的最佳治疗方法。方法:收集整理2015年1月至2016年6月,收治的4例阴茎、阴囊坏疽患者的临床诊治资料,回顾分析其治疗过程中配合使用封闭式负压引流技术的方法及其疗效。4例患者均早期行广泛、彻底的阴囊、阴茎坏疽清创术,并静脉应用二联广谱抗生素,清创后为充分创面引流,应用封闭式负压引流(VSD),待创面清洁后,予以创面缝合。结果:4例患者经配合使用封闭式负压引流技术后,坏疽创面引流更加充分,阴囊、阴茎坏疽范围快速局限化,未出现睾丸坏死情况。4例患者均在坏疽创面清洁后,二期缝合,创面顺利愈合后出院。3个月后随访,局部创面愈合良好,无复发。结论:应用封闭式负压引流冲洗技术配合早期行广泛、彻底清创可有效促进坏疽范围的局限化,显著降低换药频率和缩短患者住院周期,是治疗阴茎阴囊坏疽的极为有效的辅助治疗手段。     

阴囊坏疽的诊断和治疗(附9例报告)

目的：探讨阴囊坏疽的诊断及治疗方法。方法：回顾性分析9例阴囊坏疽患者的临床资料，对9例患者均行早期多切口切开引流和广泛清创。结果：7例患者坏疽创面愈合良好，1例行二期睾丸切除术后愈合；1例死亡。患者生存率为88．8％。结论：阴囊坏疽的治疗以早期多切口切开引流、广泛清创、使用足量广谱抗生素、全身支持治疗及局部治疗、原发病治疗为主。注意卫生、保持局部清洁及提高卫生保健意识是其重要预防措施。     

Fournier坏疽的诊治(附16例报告)

目的　探讨Fournier坏疽的诊断及治疗。　方法　对 16例男性Fournier坏疽患者的临床资料进行分析。患者年龄 2 4～ 84岁 ,平均 5 1岁。其中阴囊坏疽 13例 ,阴茎皮肤坏疽 3例。细菌培养 14例 ,阳性 9例。 16例均行外科清创、引流、抗感染等治疗 ,4例行高压氧治疗。　结果　 13例经二期缝合痊愈出院 ,其中 2例 1个月后取皮瓣行阴茎、阴囊成形术。死亡 3例 ,其中 2例并发败血症 ,1例高龄患者早期出现肾功能受损而致多器官功能衰竭。　结论　治疗以早期广泛清创及应用广谱抗生素为主 ,加强局部引流 ,有条件者可行高压氧治疗。     

阴囊坏疽行阴囊修复重建

目的总结阴囊坏疽的临床特征和诊治方法。方法复习2015年7月至2016年10月诊治的3例阴囊坏疽致阴囊缺损患者临床资料。结合文献资料分析和讨论阴囊坏疽的特征及治疗。结果所有患者均早期、反复清创、封闭负压引流、股前外侧穿支皮瓣转移修复重建,取得良好的效果。结论早期清创、引流后应用封闭负压引流技术,联合股前外侧穿支皮瓣转移是治疗阴囊坏疽致阴囊缺损修复重建的良好方法。     

多孔负压引流在阴囊Fournier坏疽治疗中的应用

目的:探讨多孔负压引流在Fournier坏疽治疗中的临床价值并总结该病诊治方法。方法:回顾2005年1月~2015年4月我院收治的3例阴囊Fournier坏疽患者,总结诊疗经验并复习相关文献。结果:2例患者给予阴囊坏疽清创术,术后给予多孔负压引流术。术后患者双侧阴囊恢复正常大小,阴囊可见肉芽组织,渗液及坏死物逐渐消退。1个月后随访,阴囊创面基本愈合,至今未复发。另1例患者因自动出院失去随访。结论:广泛阴囊坏死组织清创+多孔负压引流对治疗Fournier坏疽的效果安全有效,值得推广。     

阴囊部位Fournier坏疽的外科诊疗分析

目的通过分析阴囊部位Fournier坏疽的临床特点、外科诊疗过程及疗效,探讨处理此类疾病的有效方法。方法收集自2015年8月至2017年8月治疗阴囊部位Fournier坏疽的8例患者的临床资料,并对临床诊断、创面清创及后期创面重建过程及治疗结果进行回顾性分析。结果 8例患者阴囊部位细菌培养均呈阳性。UFGSI和LRINEC中位评分为4(2～8)分和2(1～5)分,分数高低与住院天数及病情严重程度相符。其中3例经1次清创、5例经2次清创,之后采用负压辅助系统治疗;待创面新鲜后,采取直接缝合1例,局部皮瓣修复1例,自体中厚皮片植皮6例,均痊愈出院。中位随访16.5(11～23)个月,创面愈合良好,无复发。结论患者的临床表现、细菌培养和UFGSI、LRINEC评分,对于阴囊部位Fournier坏疽的诊断和预后判断具有重要意义。在控制基础疾病的同时,采取早期多次清创,并应用负压辅助系统,以及后期根据创面情况来选择合适的重建方式,均可获得较好的预后效果。     

Fournier坏疽1例报告并文献复习

目的:探讨Fournier坏疽(fournier’s gangrene,FG)的病因、诊断要点和治疗方法,提高对该疾病的认识。方法:回顾性分析我院收治的1例FG患者的资料,并复习相关文献。结果:患者阴囊、会阴部、阴茎皮肤完全坏疽,经过积极的手术清创引流,使用足量广谱抗生素,全身支持治疗,在创面无明显炎症反应并长出新鲜肉芽组织后,行植皮术重塑阴囊、会阴部、阴茎皮肤,患者治愈出院。结论:FG病情凶险,病死率高,应早期诊断,一旦确诊应积极采取手术清创(切开)引流和广谱(敏感)抗生素治疗,如有皮肤缺损,应在创面无炎性渗出并长出新鲜肉芽组织后,及时行植皮或皮瓣转移术闭合皮肤缺损。     

Fournier's gangrene following vasectomy

Routine vasectomy was performed on a 29-year old man for whom rheumatoid arthritis had been diagnosed 4 years previously and treated with nonsteroidal anti-inflammatory drugs. The man experienced a flare-up of arthralgia in the wrists 2 weeks prior to the vasectomy. He was treated with a single course of parenteral methyl prednisolone and was in remission at the time of the surgery. On the day following the vasectomy, the patient noticed some erythema around the wound and felt unwell but did not seek medical advice until 4 days later. He was clinically toxic when he presented and experiencing painful gangrene of the scrotum. Treatment was begun immediately with parenteral benzyl penicillin, tobramycin and metronidazole plus aggressive debridement; 30 ml of pus drained and beta hemolytic streptococci Group A, sensitive to penicillin, were cultured. Within a few hours, further spread of gangrene along the penile shaft was noted. He was given hyperbaric oxygen treatment for 3 days followed by secondary debridement. No further spread of the gangrene occurred. 1 week later there was a good tranulating bed over the anterior scrotum. Meshed split skin graft was applied with tie-over dressings. An almost 100% take was achieved 4 weeks later. If hyperbaric oxygen had been employed immediately after surgery, spread of the gangrene might have been avoided. The use of hyperbaric oxygen should be considered as a firstline treatment.     

Management of perineal necrotizing fasciitis (Fournier's gangrene)

Eleven cases of perineal necrotizing fasciitis were treated in the Department of Surgery, University of Turku, Finland. In 10 cases the diagnosis was made on the basis of the fulminating progression of the infection to scrotal gangrene, identification of multiple underlying pathogenic organisms and toxaemia. In one female patient a corresponding infection developed in the labia majora. Each patient suffered nonspecific symptoms before the gangrene became evident. The management included surgical debridement of the necrotic tissue with incisions and drainage of the involved areas, antibiotic therapy and hyperbaric oxygen (HBO) treatment. The infection originated from the anorectal area in 5 patients, 1 patient had sustained scrotal trauma and in 5 cases the underlying condition was unknown. Colostomy was performed in 6 patients. One patient died 2 days after the admission. All the infections proved to be multimicrobial. Hyperbaric oxygenation was employed as a therapeutic adjunct in the present series, but it should neither replace nor delay surgical intervention. The key points in the management include early diagnosis with prompt surgical debridement and antibiotic therapy. After healthy granulation has appeared, the healing time can be shortened with reconstructive surgical procedures.     

Predisposing factors and treatment outcome in Fournier's gangrene. Analysis of 28 cases

OBJECTIVES: To evaluate the etiologic factors and the effects of surgical debridement and adjunctive therapies on morbidity and mortality of Fournier's gangrene. METHODS: 27 males, 1 female, a total of 28 patients with a mean age of 58 years treated for Fournier's gangrene were evaluated retrospectively. RESULTS: Predisposing factors including diabetes, alcohol abuse, paraplegia and renal insufficiency were identifiable in 54% of the patients. Etiologic origin of the gangrene was urogenital, cutaneous and anorectal in 43, 25 and 11% of the patients, respectively. The pathology was limited to genitalia in 10, extending to perineum in 8, the umbilicus in 7 and even up to the axilla in 3 patients. Suprapubic cystostomy and colostomy were necessary in 18 and 2 cases, respectively. We used hyperbaric oxygen therapy in 2 and honey in 6 patients to accelerate wound healing. A repeat debridement was necessary in 39% of the cases. Plastic surgery and grafting were done in 14 patients. Our mortality rate was 7%. CONCLUSION: Early recognition of the pathology and aggressive surgical debridement are the mainstay of the management of Fournier's gangrene. Additional strategies to improve wound healing and increase patient survival are also needed.     

应用封闭式负压引流技术辅助治疗阴囊坏疽体会（附8例报告）

目的观察应用封闭负压引流技术辅助治疗阴囊坏疽的临床效果。方法对我科于2005年6月-2010年10月诊治的阴囊坏疽8例进行回顾性分析。本组患者局限于阴囊5例,并发双侧腹股沟区,阴茎皮下坏疽2例;并发肛周,左侧腹股沟区坏疽1例。8例均进行手术清创,并应用VSD持续负压吸引,同时给予抗感染对症治疗。拆除敷料创面干净后行二期手术。结果 6例使用VSD1次,行II期直接缝合后愈合;2例使用VSD2次,行腹股沟皮瓣转移后愈合。结论在清创后配合使用封闭式负压引流技术是治疗阴囊坏疽的一种有效方法,封闭式负压引流技术能够促进伤口的愈合,明显缩短治疗时间,减少换药次数,而且简单易行,值得推广。     

Life-threatening cellulitis,or Fournier's gangrene of the perineum

The global mortality for Fournier's gangrene is one in five. In half the cases, the infection is polymicrobial with either anaerobes or gram negative bacilli. Factors which worsen prognosis include renal insufficiency, streptococcal infection, or need for hospital admission. Diagnosis must be prompt and treatment multidisciplinary involving the surgeon, intensivist, and infectious disease specialist; early and adequate surgical debridement must be accompanied by well-chosen antibiotics and hyperbaric oxygen therapy. Post-debridement therapy requires a long period of dressing changes and skin grafting to achieve final wound closure. This is an aggressive disease with a high mortality, but the depth and extent of invasive infection does not determine prognosis; the first priority is prompt and wide surgical excision/debridement of infected tissues to pre-empt the development of systemic sepsis; this should not be deferred while arranging transfer to a facility with a hyperbaric chamber.     

Fournier坏疽23例报告

目的:探讨Fournier坏疽的诊断治疗措施。方法:回顾性分析23例Fournier坏疽的诊断和治疗方法。23例患者外阴均红肿、疼痛,并迅速阴囊坏疽,并发不同程度的阴茎、肛周、会阴、腹股沟、下肢坏疽。23例患者分别采取早期清创术,切开引流,抗炎及高压氧治疗。Ⅱ期有11例行阴囊成形术,7例行阴茎阴囊植皮术,2例阴茎坏死者行阴茎切除术后尿道外口成形术。1例行膀胱造瘘术,1例行结肠造瘘术。结果:20例痊愈,3例死亡。结论:Fourn ier坏疽病情凶险,早期诊断、外科综合治疗是治愈的关键。     

Fournier's gangrene in an HIV-positive patient. Therapeutic options

Fournier's gangrene is a life-threatening necrotising infection of the perineal and genital regions. The case presented here refers to an HIV-positive 42-year-old man, admitted in emergency to our department with clinical signs and symptoms of sepsis related to gangrene of the perineum and scrotum. An early wide surgical necrosectomy was performed under epidural anaesthesia. Treatment was completed by intensive care, broad-spectrum antibiotics and hyperbaric oxygen therapy. The wound was managed with advanced dressing (AQUACEL Hydrofiber) until complete healing was obtained, and the scrotum was reconstructed with skin flaps. The disease did not involve the testes, spermatic cord or anorectal canal. The satisfactory aesthetic and functional outcome prompts the authors to stress a number of features of the therapeutic approach adopted: (i) the advantages of epidural anaesthesia with an indwelling catheter that allows further necrosectomy and wound dressing to be performed totally painlessly; (ii) the possibility of avoiding faecal diversion by means of synthetic opioid drugs which are useful to reduce the frequency of defecation; and (iii) the positive impact of advanced dressing on the wound healing process in relation to patient satisfaction and cost management.