坏死性筋膜炎的救治

doi:10.3877/cma.j.issn.2095-9133.2017.05.005

中华卫生应急电子杂志 ›› 2017, Vol. 03 ›› Issue (05) : 272 -276. doi: 10.3877/cma.j.issn.2095-9133.2017.05.005

所属专题：文献；

论著

坏死性筋膜炎的救治

李垒¹, 刘保池²^,^†(

), 俞晓峰³, 司炎辉¹, 张伟伟¹, 刘新¹, 刘启领¹, 冯铁男⁴

^1. 201508　上海市公共卫生临床中心外科
^2. 201508　上海市公共卫生临床中心外科；215000　苏州高新区人民医院普外科
^3. 215000　苏州高新区人民医院普外科
^4. 200025　上海交通大学公共卫生学院

收稿日期:2017-07-22 出版日期:2017-10-18
通信作者: 刘保池

Treatment of Necrotizing fasciitis

Lei Li¹, Baochi Liu²^,^†(), Xiaofeng Yu³, Yanhui Si¹, Weiwei Zhang¹, Xin Liu¹, Qiling Liu¹, Tienan Feng⁴

^1. Department of Surgery, Shanghai Public Health Clinical Center, Shanghai 201508, China
^2. Department of Surgery, Shanghai Public Health Clinical Center, Shanghai 201508, China; Department of general surgery, The people’s hospital of SND, Suzhou 215000, China
^3. Department of general surgery, The people’s hospital of SND, Suzhou 215000, China
^4. College of public health, Shanghai Jiao Tong University, Shanghai 200025, China

Received:2017-07-22 Published:2017-10-18
Corresponding author: Baochi Liu
About author:
Corresponding author: Liu Baochi, Email: 15001916546@163.com

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目的

研究坏死性筋膜炎的临床特点和治疗方法。

方法

回顾性分析上海市公共卫生临床中心2010年1月至2017年4月期间收治的26例坏死性筋膜炎患者的临床资料，其中男性21例，女性5例；年龄(47.3±11.2)岁。患者分为两组，常规手术清创换药组及手术清创VSD负压吸引组，对比两组之间术前白细胞、血红蛋白等及术后住院时间等。

结果

26例患者中病变部位下肢11例，肛周12例，腹部3例。8例感染性休克中，4例死亡。常规切开引流手术12例，平均住院时间(26±8)d, VSD引流24例，平均住院时间(19±6) d。VSD引流治疗明显缩短住院时间(P<0.05)。

结论

坏死性筋膜炎进展迅速，合并感染性休克病死率很高。彻底清创引流是最重要的治疗手段，用VSD引流治疗在相同效果下可以缩短住院时间。

关键词: 坏死性筋膜炎, 清创, 负压引流, 脓毒症, 脓毒性休克

Objective

To study the clinical features and the treatment methods of Fournier’s Gangrene (FG).

Methods

Twenty-six patients who were admitted to surgical unit of Shanghai Public Clinical Center presenting with FG between January 2010 and April 2017 were reviewed, including 21 men and 5 women. The average age was 47.3±11.2 years old. Patients were divided into conventional surgery debridement dressing group and surgical debridement plus VSD negative pressure suction group. Preoperative leukocytes, hemoglobin and postoperative hospital stay were compared between the two groups.

Results

11 cases had sites of gangrene at leg. 12 cases had sites around anal. 3 cases were at abdomen. 8 patients occurred septic shock, among which 4 patients died. 12 patients received normal incision while 24 received VSD. Average hospitalization time of normal incision with drainage was 26±8 days while that of vacuum sealing drainage was 19±6 days. VSD reduce average hospitalization time significantly (P<0.05).

Conclusions

Necrotizing fasciitis (NF) is an acute, rapidly progressive and severe surgical disease and had a high mortality rate caused by septic shock. Debridement and drain age is a main treatment for it. Additional VSD can reduce average hospitalization time with same effort.

Key words: Necrotizing fasciitis, Debridement, Vacuum sealing drainage, Sepsis, Septic shock

表1 常规引流与VSD引流比较(例)

组别	例数(例)	年龄(岁，±s)	白细胞(±s)	血红蛋白(±s)	血小板(±s)	糖尿病(例)	创伤(例)	肛周脓肿(例)	HIV感染(例)	感染性休克(例)	住院天数(d，±s)	病死率(%)
常规引流组	12	46±12	15.6±12	11.6±7.2	95±32	4	2	4	1	4	26±8	16.67
VSD引流组	14	47±14	14.8±11	10.4±6.8	97±42	6	3	7	2	4	19±6	14.29
t/χ²值	?	0.053	0.049	0.12	0.036	0.248	0.094	0.735	0.224	0.069	2.54	0.028
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	>0.05

表1 常规引流与VSD引流比较(例)

组别	例数(例)	年龄(岁，±s)	白细胞(±s)	血红蛋白(±s)	血小板(±s)	糖尿病(例)	创伤(例)	肛周脓肿(例)	HIV感染(例)	感染性休克(例)	住院天数(d，±s)	病死率(%)
常规引流组	12	46±12	15.6±12	11.6±7.2	95±32	4	2	4	1	4	26±8	16.67
VSD引流组	14	47±14	14.8±11	10.4±6.8	97±42	6	3	7	2	4	19±6	14.29
t/χ²值	?	0.053	0.049	0.12	0.036	0.248	0.094	0.735	0.224	0.069	2.54	0.028
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	>0.05

图3 疤痕愈合后的左下腹壁坏死性筋膜炎

图8 创面植皮后愈合良好

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