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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。 相似文献
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特发性阴囊坏疽的诊治 总被引:3,自引:1,他引:2
邢金春 《临床泌尿外科杂志》2001,16(5):211-212
目的:探讨特发性阴囊坏疽的诊治方法。方法:回顾分析21例特发性阴囊坏疽患者的临床资料,结果:对21例患者均行早期多切口切开引流和广泛的清创,90.0%的患者行膀胱造口术,生存率为90.5%,结论:早期多切口切开引流,广泛清创,快速纠正休克,及时使用广谱抗素,以及全身支持治疗和必要的重复清创是治疗成功的关键。 相似文献
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Takanori Ochiai Kazutoshi Ohta Masayasu Takahashi Shigeru Yamazaki Takehisa Iwai 《Surgery today》2001,31(6):553-556
Fournier's gangrene (FG) is a fatal infectious disease with necrotic fasciitis of the external genitalia. This disease persists
to this day in spite of recent advances in antibiotics. Although fewer than 100 cases have been reported in Japan, we have
treated six cases in the last 4 years. The patients consisted of five men and one woman, with an average age of 47.5 years.
All patients received surgical treatment including incisions, aggressive debridement, drainage, irrigation, and antibiotic
therapy. Two patients, who suffered from underlying diseases of diabetic nephropathy and inclusion body myositis, died. These
findings confirm the fact that FG requires a prompt diagnosis and immediate surgical treatment.
Received: April 10, 2000 / Accepted: November 20, 2000 相似文献
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Fournier's gangrene is uncommon in pediatric age group, and little is known about the disease in the newborn period and infancy.Three patients, aged 10 days, 14, and 17 months, with Fournier's gangrene, were treated in our hospital. The predisposing factors were prematurity, a diaper rash, and varicella infection, respectively.Especially, prematurity and diaper rash are rare predisposing factors in the pediatric population; therefore, high index of suspicion, prompt diagnosis, conservative surgery, and multidisciplinary approach are the mainstays of management in children with Fournier's gangrene. 相似文献
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A life-threatening infection: Fournier's gangrene 总被引:1,自引:0,他引:1
Fournier's gangrene is a life-threateningdisorder in which infection of the perineum andscrotum spreads along fascial planes, causingsoft tissue necrosis. If urgent surgery isdelayed, the disease will soon result in septicshock, multiorgan failure, and death. In thisstudy, we present 21 patients with Fournier'sgangrene who were treated in period between1994 and 2001. Patients' charts were reviewedretrospectively and are discussed in the lightof literature.All patients received aggressive surgicaldebridment. Penicillin or Ceftriaxone,aminoglicoside and metronidazole wereadministered intravenously. Of the 21 patients,5 had scrotal carbuncle, 1 had urethralstricture, 1 had chronic indwelling urethralcatheterization, 2 had perirectal abscess, and1 had hemorrhoidectomy. In eleven patients wecouldn't identify any cause. Twelve patientshad diabetes mellitus, and two had chronicalcoholism. Escherichia coli was isolatedin 12 purulent tissue cultures, and Bacteroides fragilis in eight. Seventeenpatients survived, whereas four died.Fournier's gangrene is considered a surgicalemergency. Early surgical intervention isessential, as the gangrene can spread rapidlyat rates reaching 2 mm per hour. So thatFournier's gangrene is an abrupt, rapidlyprogressive, gangrenous infection of theexternal genitalia and perineum and is a realurologic emergency. 相似文献
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P. Schaller Z. Akcetin R. Kühn C. Radu J. Geldmacher 《European journal of plastic surgery》1994,17(5):261-263
Summary Fournier's gangrene is a rare but life-threatening condition in western countries; it consists of acute subcutaneous necrotizing infection of the genital and perineal region. Predisposing diseases are characteristically those which impair the patient's immunological defense and wound healing. After emergency debridement, there is extensive loss of scrotal and perineal tissue, usually these defects heal satisfactorily by secondary intention, and reconstructive procedures are seldom indicated. Defects of the penis, abdomen or thighs are split skin grafted, while for scrotal reconstruction, various methods are recommended, such as medial thigh fasciocutaneous flaps, bilateral superolateral thigh flaps or bilateral gracilis musculocutaneous flaps. In Fournier's gangrene due to predisposing disease, split-thickness skin grafting in scrotal reconstruction can, in the authors' opinion, achieve excellent results. In addition, it is the least disabling reconstructive procedure in such patients. 相似文献
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目的 比较两种预后评分系统在我国Fournier坏疽患者死亡风险预测中的适用情况.方法 回顾性分析15例Fournier坏疽患者的临床特点及治疗转归,将研究对象分为存活组(A组)和死亡组(B组),并应用Fournier坏疽严重程度指数(FGSI)和Uludag FGSI进行死亡风险评估,采用受试者工作特征曲线(ROC)进行评分表效果评估,并利用Z检验比较FGSI和UFGSI之间准确性的差异.结果 存活组(A组)11例,死亡组(B组)4例.平均年龄(P =0.024)及术前美国麻醉师协会(ASA)评分(P =0.04)B组均显著高于A组.A组患者接受的清创次数明显多于B组患者.FGSI评分A组低于B组[(1.6±0.9)vs (3.8±1.7),P<0.05].ROC曲线下面积(AUR) =0.886.UFGSI评分A组明显低于B组[(3.6±1.5)vs(6.0±2.2),P<0.05],ROC AUR=0.852.UFGSI和FGSI的AUC比较差异无统计学意义.结论 FGSI和UFGSI均可有效预测我国Fournier坏疽患者的死亡风险,并且两种评分系统差异无显著统计学意义,但适合我国患者的死亡评估阈值还需要进一步大样本研究重新确定. 相似文献
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Ralf Czymek Andreas Schmidt M.D. Christian Eckmann M.D. Ralf Bouchard M.D. Birgit Wulff M.D. Tillmann Laubert M.D. Stefan Limmer M.D. Hans-Peter Bruch M.D. Peter Kujath M.D. 《American journal of surgery》2009,197(2):168-383
Background
Fournier's gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement.Methods
Data from 35 patients with Fournier's gangrene were prospectively collected (1996-2007). Once the patients were stabilized following surgery, they were treated with either daily antiseptic (polyhexanide) dressings (group I, n = 16) or vacuum-assisted closure (VAC) therapy (group II, n = 19).Results
The mean age of the patients was 58.2 years in group I and 57.2 years in group II. In both groups, the most common predisposing conditions were diabetes mellitus, chronic alcoholism, and obesity. Escherichia coli, streptococcal species, Pseudomonas aeruginosa, and Staphylococcus aureus were the most frequently isolated organisms. Length of hospital stay was 27.8 days ± 27.6 days (mortality: 37.5%) in group I and 96.8 days ± 77.2 days (mortality: 5.3%) in group II. Enterostomies were performed in 43.8% of group I patients and in 89.5% of group II patients.Conclusions
VAC was associated with significantly longer hospitalization and lower mortality. A partial explanation is that some patients with severe sepsis died within the first 3 days after admission and thus could not undergo vacuum therapy. Since our clinical experience has shown that vacuum dressings are particularly effective in the management of large wounds, we use VAC primarily for this indication despite the considerable material requirements involved. 相似文献11.
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Fournier's gangrene, or synergistic gangrene of the male external genitalia is a rapidly spreading necrotising infection of the penis and scrotum. Although not so frequent in our civilized world it is by no means rare. In early days it was characterised by a high mortality. Aggressive surgical debridement, broad spectrum antibiotics and plastic reconstructive technics have all contributed to a better survival of the patients. 相似文献
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Background
Vacuum Assisted Closure (VAC; Kinetic Concepts, Inc., San Antonio, TX) has been used to successfully treat a variety of complex wounds. This technique was investigated for use in managing Fournier's gangrene following initial debridement.Methods
Ten patients with Fournier's gangrene were treated in this study. After initial surgical debridement, 5 were treated using conventional therapy and 5 were treated with VAC at each dressing change. The effectiveness and cost of VAC for this indication were assessed; patient and physician satisfaction were also determined.Results
Conventional and VAC treatment were equally effective in healing the wounds. The total costs of each treatment were similar. With the use of VAC, patients had fewer dressing changes, less pain, fewer skipped meals, and greater mobility. Hands-on treatment time was decreased for physicians using VAC.Conclusions
VAC therapy is an effective and economical way to manage Fournier's gangrene. Patients and physicians were more satisfied with VAC therapy than with conventional treatment. 相似文献14.
Basoglu M Ozbey I Atamanalp SS Yildirgan MI Aydinli B Polat O Ozturk G Peker K Onbas O Oren D 《Surgery today》2007,37(7):558-563
Purpose Fournier's gangrene is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall
along with the scrotum and penis in men and the vulva in women.
Methods The clinical and operative records of 45 patients with Fournier's gangrene during a 14-year period were analyzed.
Results The etiology of the infection was identified in 39 patients. The most common causes were colorectal diseases and urogenital
diseases. Four patients died with an overall mortality of 8.8%. The mortality rate was higher in patients with diabetes mellitus,
but it was not statistically different. The age, duration of the symptoms, and the presence of rectal abscess were not found
to be significant factors regarding mortality rate.
Conclusions Surgery with extensive debridement of all necrotic tissue is the main stay of treatment. 相似文献
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G. G. Hallock 《European journal of plastic surgery》1996,19(2):105-106
Massive penoscrotal skin loss, frequently a sequela of Fournier's gangrene, can sometimes be successfully treated using skin grafts alone. If the urological debridement has been extensive with a concomitant disruption of the urethra, a regional vascularized flap must be introduced. A superiorly based fasciocutaneous flap can be constructed on the medial thigh to provide scrotal reconstruction. The underlying gracilis muscle is an ideal onlay patch for ventral penile defects. Simultaneous use of independent, multiple flaps from a single medial thigh donor site allows coverage of separate penile and scrotal deformities, and leaves only a linear scar. 相似文献
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Fournier's gangrene: a review of 1726 cases 总被引:16,自引:0,他引:16
Eke N 《The British journal of surgery》2000,87(6):718-728
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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。 相似文献
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Ayan F Sunamak O Paksoy SM Polat SS As A Sakoglu N Cetinkale O Sirin F 《ANZ journal of surgery》2005,75(12):1055-1058
BACKGROUND: Fournier's gangrene, first described by Dr Jean Alfred Fournier in 1883, still has a high mortality rate. The prognosis and outcome of such patients were analysed. METHODS: Forty-one patients with Fournier's gangrene were reviewed on the parameters of age, sex, aetiological agents, predisposing factors, treatment modalities and outcomes. RESULTS: Although early intervention and careful treatment was carried out, nine of 41 patients (21.9%) died as a result of complications of septicemia. Among the treatment modalities, there were extensive debridement, drainage, excisions of the skin and fascia, colostomy procedure, extensive antibiotic treatment and hyperbaric oxygen therapy. Although a combination of different treatment modalities were used, the mortality rate was 21.9%. CONCLUSIONS: Fournier's gangrene is still a severe disease. Today, hyperbaric oxygen treatment is very effective in the treatment of this disease. 相似文献