Outcomes in patients with Fournier's gangrene originating from the anorectal region with a particular focus on those without perineal involvement
Outcomes in patients with Fournier's gangrene originating from the anorectal region with a particular focus on those without perineal involvement
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源自肛门直肠区域的福尼尔坏疽患者的结果，特别关注那些没有会阴受累的患者
DOI：
10.1093/gastro/goy041
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发表时间：
2019-06-01
影响因子：
3.6
通讯作者：
Ren, Dong-Lin
中科院分区：
文献类型：
--
作者：
Lin, Hong-Cheng;Chen, Zu-Qing;Ren, Dong-Lin
背景与目的：Fournier坏疽（FG）是一种发生于外生殖器和会阴部的暴发性感染。本研究探讨了源于肛门直肠区域的FG的临床特征，其原发疾病如肛瘘和肛瘘。对中山大学附属第六医院和福建中医药大学附属人民医院两所医院的FG患者进行回顾性分析，以确定与临床结局相关的因素，结果：60例FG患者纳入本研究。培养的常见致病微生物为大肠埃希菌。生殖器和直肠周围区域的参与是明显的，分别在52和59例，虽然会阴未受影响的7例（12%），证实了影像学检查和手术探查。早期彻底清创和广谱抗生素治疗是有效的，脓毒症死亡率可接受（1.7%）。10例患者接受了保护性结肠造口术。没有病人接受了前列腺切除术，需要urinary diversion.Conclusions：FG起源于肛门直肠区域可以迅速进行性和危及生命。感染可以向上扩散到生殖器区域，而不累及会阴组织。积极的外科清创术的无活力组织是必要的，令人满意的结果和保护性结肠造口术是不是强制性的。
Background and aim: Fournier's gangrene (FG) is a fulminant infection in the external genital region and perineum. The present study explored the clinical features of FG originating from the anorectal region, from primary conditions such as anal fistulas and abscesses.Methods: A retrospective analysis was performed in order to identify the factors associated with clinical outcomes in FG patients derived from two hospitals-the Sixth Affiliated Hospital of Sun Yat-sen University and People's Hospital Affiliated to Fujian University of Traditional Chinese-over the period from May 2013 to April 2017.Results: Sixty FG patients were included in this study. The common causative microorganisms cultured were Escherichia coli species. Genital and perirectal regional involvement was evident in 52 and 59 cases, respectively, although the perineum was unaffected in 7 cases (12%), as confirmed by imaging examination and surgical exploration. Management with early radical debridement and broad-spectrum antibiotic therapy is effective with an acceptably sepsis mortality (1.7%). Ten patients underwent protective colostomy. No patient underwent an orchidectomy and required urinary diversion.Conclusions: FG originating from the anorectal region can be rapidly progressive and life-threatening. Infection can spread superiorly to the genital region without the involvement in perineal tissue. An aggressive surgical debridement of nonviable tissue is essential for satisfactory outcomes and a protective colostomy is not mandatory.