会阴部坏死性筋膜炎临床诊治与误诊分析

目的探讨会阴部坏死性筋膜炎的发病机制、治疗要点及误诊原因,提高该病的临床诊疗水平。方法对8例误诊的会阴部坏死性筋膜炎患者的临床资料进行回顾性分析,总结其误诊原因,并在明确诊断后采用手术切开引流配合湿润烧伤膏药纱引流治疗,观察、分析该疗法的有效性,并归纳总结该病的诊疗方案。结果 8例患者中有6例因痔疮史被误诊为"肛周脓肿";1例因阴囊处皮肤被蚊虫叮咬后肿痛、体温升高被误诊为"皮肤软组织感染";1例因会阴部皮肤触痛且有硬结被误诊为"巴氏腺囊肿"。8例患者中有7例在切开引流术后经单纯应用湿润烧伤膏药纱引流治疗14~20 d后创面愈合;另外1例经湿润烧伤膏药纱引流治疗至肉芽组织完全覆盖创面后,给予手术植皮封闭创面,术后1个月创面完全愈合。所有患者随访0.5~6年,均未复发。结论临床医生应加强对会阴部坏死性筋膜炎的认识,选择合适的治疗方案,以减少误诊误治。

Analysis of Clinical Diagnosis and Misdiagnose of Perineal Necrotizing Fasciitis

Objective To investigate the pathogenesis of perineal necrotizing fasciitis, the key points of its treat-ment and causesof misdiagnosis, and to improve the level of clinical diagnosisand treatment. Methods The clinical data of 8 cases of misdiagnosed perineal necrotizing fasciitis were retrospectively analyzedto summarize the causes of misdiagnosi. Afterdefinite diagnosiswas made, surgical drainagewas appliedto assist MEBO gauze drainage. Theefficacy of thiscombined therapy was observedand analyzed and the protocolfordiagnosis and treatment wasconcluded. Results Among the 8 pa-tients, sixwas misdiagnosed as perianal abscessdue to hemorrhoids history; onewas misdiagnosed asskin soft-tissue infec-tiondue toswelling and fevercaused bymosquito bitesonscrotum skin; one was misdiagnosed as Bartholin’ s gland cyst due to perineal skin tenderness and induration. Eightpatients werefirst treated by surgical drainage, after which sevenweretreated with only MEBO gauze drainageandhealed 14-20 days later;theremaining case was treated with MEBO gauze drainage until the granulation tissues completely covered the wound, and then the wound was closed bysurgical skin grafting and healed one month after the surgery. Allpatients were followed up for 0.5 to 6 yearsand no relapse was found. Conclusion Clinicians should improve their understanding of perineal necrotizing fasciitisand chooseappropriate treatment plan, in order to reduce misdiagnosis and mistreatment.