肛周坏死性筋膜炎13例的临床分析

目的探讨肛周坏死性筋膜炎的诊断及治疗方法。方法对中国医科大学附属第一医院肛肠外科自2008年9月-2011年8月间收治的13例肛周坏死性筋膜炎患者全部行肛周清创引流术。术中充分引流清创,并抽取脓汁作细菌培养和药敏试验。术后给抗炎、对症、支持治疗。结果本组13例患者全部治愈。平均手术时间为130 min。术后常规应用美罗培南7～10 d,并监测血常规。术后第3天WBC降至(10.5～11.7)×109/L,中性粒细胞百分率降至79%～84%;术后第7天WBC降至(8.7～10.3)×109/L,中性粒细胞百分率降至63%～71%。体温降至36.7～37.2℃。患者住院天数为15～24 d,平均住院日为21 d,平均住院费用15 605.41元。所有患者随访1年,未发现复发。结论早期诊断并给予彻底的清创引流是治疗的关键,及时有效的抗炎、对症、支持治疗可以改善患者的预后。

Clinical Analysis of 13 Cases of Perianal Necrotizing Fasciitis

Objective To discuss the diagnosis and treatment of perianal necrotizing fasciitis.Methods Thirteen cases with perianal necrotizing fasciitis underwent surgery therapy which included perianal debridement,incision and drainage from Sep.2008 to Aug.2011.The pus bacterial cultivation and drug sensitive test were performed.The patients received the anti-inflammation,symptomatic and supporting treatments.Results All 13 cases were cured.The mean operative time was 130 min.On the third day,WBC decreased to(10.5-11.7)×109/L,neutrophile granulocyte decreased to 79%-84%;On the seventh day,WBC decreased to(8.7-10.3)×109/L,neutrophile granulocyte decreased to 63%-71%.The body temperature decreased to 36.7-37.2 ℃.The mean hospital stay was 21 days,mean cost was 15 605.41 yuan.One year follow up for every patient showed no occurrence.Conclusion For the perianal necrotizing fasciitis,the early corrective diagnosis,active treatment especially the incision and drainage are the key of the treatments.The timely effective anti-inflammation,symptomatic and supporting treatments can improve the prognosis of patients.